Provider Demographics
NPI:1609004589
Name:GREEN MOREHEAD, LASHONDA M (IDMT)
Entity Type:Individual
Prefix:
First Name:LASHONDA
Middle Name:M
Last Name:GREEN MOREHEAD
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 TH MDOS/SGOPF
Mailing Address - Street 2:UNIT 3215 RAMSTEIN AB, GERMANY
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09094
Mailing Address - Country:US
Mailing Address - Phone:01149637-146-2628
Mailing Address - Fax:
Practice Address - Street 1:435 TH MDOS/SGOPF
Practice Address - Street 2:UNIT 3215 RAMSTEIN AB, GERMANY
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09094
Practice Address - Country:US
Practice Address - Phone:01149637-146-2628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians