Provider Demographics
NPI:1295259653
Name:GREEN, KRISTEN M (BSC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:GREEN
Suffix:
Gender:F
Credentials:BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2058 MAPLE AVE APT AL2-6
Mailing Address - Street 2:
Mailing Address - City:HATFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19440
Mailing Address - Country:US
Mailing Address - Phone:215-512-4684
Mailing Address - Fax:
Practice Address - Street 1:2058 MAPLE AVE APT AL2-6
Practice Address - Street 2:
Practice Address - City:HATFIELD
Practice Address - State:PA
Practice Address - Zip Code:19440-1517
Practice Address - Country:US
Practice Address - Phone:215-512-4684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist