Provider Demographics
NPI:1023204278
Name:GREEN, VANESSA STREICHER (DO)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:STREICHER
Last Name:GREEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-2438
Mailing Address - Country:US
Mailing Address - Phone:931-450-1000
Mailing Address - Fax:931-450-1004
Practice Address - Street 1:1402 WILLOW DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2438
Practice Address - Country:US
Practice Address - Phone:931-450-1000
Practice Address - Fax:931-450-1004
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO2464207V00000X
TN2464207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6039532OtherSRIPA
TN602699OtherBCBST
TNP01412339OtherRR MEDICARE
TNQ001504Medicaid
TN602699OtherBCBST