Provider Demographics
NPI:1962262642
Name:GREEN, PAMELA SUE
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:SUE
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3623
Mailing Address - Country:US
Mailing Address - Phone:517-769-4516
Mailing Address - Fax:
Practice Address - Street 1:2260 MAPLE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3623
Practice Address - Country:US
Practice Address - Phone:517-769-4516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health