Provider Demographics
NPI:1346952033
Name:GREEN, CHAVONNA
Entity Type:Individual
Prefix:
First Name:CHAVONNA
Middle Name:
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 1:1079 SUNRISE AVE STE B223
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-7009
Mailing Address - Country:US
Mailing Address - Phone:844-693-7689
Mailing Address - Fax:
Practice Address - Street 1:1079 SUNRISE AVE STE B223
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7009
Practice Address - Country:US
Practice Address - Phone:844-693-7689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula