Provider Demographics
NPI:1841431533
Name:GREEN, DANA R (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:R
Last Name:GREEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:HANCHETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:330 HIGH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2672
Mailing Address - Country:US
Mailing Address - Phone:541-690-4104
Mailing Address - Fax:
Practice Address - Street 1:330 HIGH ST APT 1
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2672
Practice Address - Country:US
Practice Address - Phone:541-690-4104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANA00168643376K00000X
WAMA00018764225700000X
OR19945225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No376K00000XNursing Service Related ProvidersNurse's Aide