Provider Demographics
NPI:1306091475
Name:GREEN, VICTORIA ANN (NMD)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:ANN
Last Name:GREEN
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4341 E ORCHID LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-9676
Mailing Address - Country:US
Mailing Address - Phone:480-650-1013
Mailing Address - Fax:
Practice Address - Street 1:1901 E UNIVERSITY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-8306
Practice Address - Country:US
Practice Address - Phone:480-650-1013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ08-1076175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath