Provider Demographics
NPI:1083880827
Name:ROBERTS-GREEN, KATHY K (RN)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:K
Last Name:ROBERTS-GREEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 N 10TH ST
Mailing Address - Street 2:#A
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2357
Mailing Address - Country:US
Mailing Address - Phone:406-532-9101
Mailing Address - Fax:
Practice Address - Street 1:209 N 10TH ST
Practice Address - Street 2:#A
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2357
Practice Address - Country:US
Practice Address - Phone:406-532-9101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT18426163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse