Individual
CHANCE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
5448 HIGHWAY 260 STE 100, LAKESIDE, AZ 85929-5736
(928) 359-1862
(928) 537-2049
Mailing address
135 N CENTER ST UNIT 5870, MESA, AZ 85211-7159
(480) 874-7014
(480) 874-7015
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28162181
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200513510
—
IN
Enumeration date
06/22/2006
Last updated
03/19/2026
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