Provider Demographics
NPI:1841967296
Name:GREEN, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
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 1:5846 KIRKSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-2348
Mailing Address - Country:US
Mailing Address - Phone:304-915-4700
Mailing Address - Fax:
Practice Address - Street 1:5846 KIRKSTONE CIR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-2348
Practice Address - Country:US
Practice Address - Phone:304-915-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVE951766OtherDRIVERS LICENSE SE