Provider Demographics
NPI:1790247823
Name:GREEN, SARAH CHINELLE (COMETOLOGIST)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:CHINELLE
Last Name:GREEN
Suffix:
Gender:F
Credentials:COMETOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3402 BROOKHOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-5006
Mailing Address - Country:US
Mailing Address - Phone:502-533-2799
Mailing Address - Fax:
Practice Address - Street 1:3402 BROOKHOLLOW DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-5006
Practice Address - Country:US
Practice Address - Phone:502-533-2799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-06
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY206490332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies