Provider Demographics
NPI:1679916084
Name:GREEN, JULIE CLAIRE (ND)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:CLAIRE
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 1:4778 HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-9537
Mailing Address - Country:US
Mailing Address - Phone:707-490-7053
Mailing Address - Fax:
Practice Address - Street 1:4778 HOLLY ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-9537
Practice Address - Country:US
Practice Address - Phone:707-490-7053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-215175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath