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Provider Information for 1316533151

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

CHARRIE LYNN GREEN

Gender: FEMALE

Individual NPI: 1316533151

Calendar   Last Updated:  2020-12-16
  Certification Date:  2020-12-16

Details

Name Value
NPI 1316533151
Enumeration Date 2020-12-16
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 413 E HOARD ST
WATERTOWN, NY 13601-1608
United States

Phone: 315-489-4824 | Fax:
View Map External Link
Primary Practice Address 413 E HOARD ST
WATERTOWN, NY 13601-1608
United States

Phone: 315-489-4824 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 193200000X MULTI-SPECIALTY GROUP
376G00000X - Nursing Home Administrator