Provider Demographics
NPI:1033802152
Name:GREEN, LAURA KATHRYN
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KATHRYN
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 1:21 POINT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01570-1530
Mailing Address - Country:US
Mailing Address - Phone:508-943-7792
Mailing Address - Fax:
Practice Address - Street 1:5 PAUL X TIVNAN DR
Practice Address - Street 2:
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-2126
Practice Address - Country:US
Practice Address - Phone:508-854-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program