Individual
MRS. DARREA L GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3700 INTERSTATE 70 DR SE, COLUMBIA, MO 65201
(573) 256-7637
Mailing address
626 CASTLE RIDGE DR, WENTZVILLE, MO 63385-3245
(314) 202-1619
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2018009728
MO
Other
Enumeration date
09/04/2018
Last updated
09/04/2018
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