Provider Demographics
NPI:1396984753
Name:GREEN, DARLENE SUSAN (LMP)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:SUSAN
Last Name:GREEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 NW GILMAN BLVD STE 8
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5398
Mailing Address - Country:US
Mailing Address - Phone:425-313-9222
Mailing Address - Fax:425-313-9339
Practice Address - Street 1:1505 NW GILMAN BLVD STE 8
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5398
Practice Address - Country:US
Practice Address - Phone:425-313-9222
Practice Address - Fax:425-313-9339
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00007556225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist