Provider Demographics
NPI:1558190272
Name:GREEN, VARQUWON LAMAR
Entity type:Individual
Prefix:
First Name:VARQUWON
Middle Name:LAMAR
Last Name:GREEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 LAFAYETTE AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-6610
Mailing Address - Country:US
Mailing Address - Phone:269-762-1337
Mailing Address - Fax:
Practice Address - Street 1:2041 E CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-4417
Practice Address - Country:US
Practice Address - Phone:269-762-1337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider