Provider Demographics
NPI:1740609007
Name:GREEN, SHARI (COM)
Entity Type:Individual
Prefix:MS
First Name:SHARI
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:COM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 RFD # 83
Mailing Address - Street 2:#203
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-9583
Mailing Address - Country:US
Mailing Address - Phone:847-641-4444
Mailing Address - Fax:
Practice Address - Street 1:4160 RFD # 83
Practice Address - Street 2:#203
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047-9583
Practice Address - Country:US
Practice Address - Phone:847-641-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAC-116-98174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist