Provider Demographics
NPI:1457916025
Name:GREEN, NATASHA LYNNETTE
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:LYNNETTE
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 1:229 S NORMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2266
Mailing Address - Country:US
Mailing Address - Phone:614-598-4688
Mailing Address - Fax:
Practice Address - Street 1:109 S WILLOW ST
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075-3833
Practice Address - Country:US
Practice Address - Phone:614-598-4688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator