Provider Demographics
NPI:1790503183
Name:GREEN, SANTANA (PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:SANTANA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1936 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5128
Mailing Address - Country:US
Mailing Address - Phone:646-288-3876
Mailing Address - Fax:
Practice Address - Street 1:1936 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5128
Practice Address - Country:US
Practice Address - Phone:646-288-3876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108-10173156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty