Provider Demographics
NPI:1912344805
Name:GREEN, LINDSEY MARIE AMMERMAN (RN)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:MARIE AMMERMAN
Last Name:GREEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 ENGMAN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SKANDIA
Mailing Address - State:MI
Mailing Address - Zip Code:49885-9571
Mailing Address - Country:US
Mailing Address - Phone:734-578-7859
Mailing Address - Fax:
Practice Address - Street 1:722 HIGH ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3720
Practice Address - Country:US
Practice Address - Phone:906-361-4950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704275491163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse