Individual
GINA LYNNE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
3304 COOLEY CT, PORTAGE, MI 49024-7430
(269) 349-2266
Mailing address
3304 COOLEY CT, PORTAGE, MI 49024-7430
(269) 718-7733
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704258294
MI
Other
Enumeration date
10/06/2022
Last updated
06/30/2025
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