Provider Demographics
NPI:1669628202
Name:GREEN, LAWANDA MARIE
Entity Type:Individual
Prefix:MS
First Name:LAWANDA
Middle Name:MARIE
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 1:190 N VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701-1672
Mailing Address - Country:US
Mailing Address - Phone:559-237-8337
Mailing Address - Fax:553-237-8342
Practice Address - Street 1:190 N VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-1672
Practice Address - Country:US
Practice Address - Phone:559-237-8337
Practice Address - Fax:553-237-8342
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator