Provider Demographics
NPI:1700024288
Name:GREEN, KARLA (LPN)
Entity Type:Individual
Prefix:MS
First Name:KARLA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2742 N 54TH ST
Mailing Address - Street 2:UPPER
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-2329
Mailing Address - Country:US
Mailing Address - Phone:414-552-3831
Mailing Address - Fax:
Practice Address - Street 1:2742 N 54TH ST
Practice Address - Street 2:UPPER
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-2329
Practice Address - Country:US
Practice Address - Phone:414-552-3831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI307563-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse