Provider Demographics
NPI:1376354613
Name:GREEN, AIREONA IYON
Entity type:Individual
Prefix:
First Name:AIREONA
Middle Name:IYON
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 PHILADELPHIA AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-2235
Mailing Address - Country:US
Mailing Address - Phone:313-618-8646
Mailing Address - Fax:
Practice Address - Street 1:1509 PHILADELPHIA AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-2235
Practice Address - Country:US
Practice Address - Phone:313-618-8646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care