Provider Demographics
NPI:1619654209
Name:GREEN, JEANETTE (BIRTH DOULA)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:BIRTH DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 58TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:MI
Mailing Address - Zip Code:49056-9535
Mailing Address - Country:US
Mailing Address - Phone:269-206-6985
Mailing Address - Fax:
Practice Address - Street 1:126 58TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:MI
Practice Address - Zip Code:49056-9535
Practice Address - Country:US
Practice Address - Phone:269-206-6985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula