Basic Information
| Provider Information | |||||||||
| NPI: | 1407521636 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREEN | ||||||||
| FirstName: | TESS | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 INDUSTRIAL RD | ||||||||
| Address2: | STE 5 | ||||||||
| City: | MILFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017573736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084731480 | ||||||||
| FaxNumber: | 5084731210 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 COMMERCE DR | ||||||||
| Address2: | |||||||||
| City: | NORTHBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015341425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087312575 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2021 | ||||||||
| LastUpdateDate: | 10/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | UNK | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.