Teresa Diane Green
Individual provider Active NPI Homemaker · Sikeston, MO
NPI 1104154293 · NPPES record last updated Nov 30, 2009
Key facts
- NPI
- 1104154293
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Homemaker 376J00000X
- License
- 19920393 (MO)
- Practice address
- 415 W Gladys St
Sikeston, MO 63801-2733 - Phone
- (573) 475-9254
- Fax
- (573) 475-9254
- NPI assigned
- Nov 30, 2009
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19920393 | MO | MD | Homemaker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Homemaker | 376J00000X | 19920393 | MO | Yes |
Addresses
Primary practice location
415 W Gladys St
Sikeston, MO 63801-2733
Mailing address
415 W Gladys St
Sikeston, MO 63801-2733
Phone (573) 475-9254
Other providers in Sikeston, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.