Provider Demographics
NPI:1225227002
Name:GREEN, WENDY PENELOPE (ND)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:PENELOPE
Last Name:GREEN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4208
Mailing Address - Country:US
Mailing Address - Phone:831-515-2010
Mailing Address - Fax:
Practice Address - Street 1:736 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3761
Practice Address - Country:US
Practice Address - Phone:541-779-0100
Practice Address - Fax:541-779-0107
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1556175F00000X
OR083-OB176B00000X
CAND1293175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No176B00000XOther Service ProvidersMidwife