Chantel Marie Green, FNP
Nurse Practitioner, Family in Jefferson City, MO. Individual provider (NPI-1).
NPI number1457075889
StatusActive
Last updated in NPPESJun 28, 2023
Details
- NPI
- 1457075889
- Entity type
- Individual (NPI-1)
- Name
- Chantel Marie Green
- Credential
- FNP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Sep 29, 2022
- Certification date
- Jun 28, 2023
- Last updated
- Jun 28, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 2022037794 | MO | Yes |
Practice location
1241 W Stadium BlvdJefferson City, MO 65109-6023
Phone 573-635-5264
Mailing address
6117 Roling RdJefferson City, MO 65101-8987
Phone 573-680-2895
Other practice locations
6117 Roling Rd
Jefferson City, MO 65101-8987
Jefferson City, MO 65101-8987
Phone 573-680-2895
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