Basic Information
| Provider Information | |||||||||
| NPI: | 1407472780 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREEN | ||||||||
| FirstName: | ALLISON | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8454 CARRIAGE LN | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488759805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5174497106 | ||||||||
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| Practice Location | |||||||||
| Address1: | 406 KENT ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488751707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5176474166 | ||||||||
| FaxNumber: | 5176472473 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2020 | ||||||||
| LastUpdateDate: | 05/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 4704307008 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.