Provider Demographics
NPI:1659128049
Name:GREEN, ARNEICE MELINDA
Entity type:Individual
Prefix:MS
First Name:ARNEICE
Middle Name:MELINDA
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 1:4218 W NANCY LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-4934
Mailing Address - Country:US
Mailing Address - Phone:602-758-3332
Mailing Address - Fax:
Practice Address - Street 1:4218 W NANCY LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-4934
Practice Address - Country:US
Practice Address - Phone:602-758-3332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32HPU0CM8B335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier