Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 134245 | CA |
N | 208600000X | Surgeon | 134245 | CA |
Y | 2086S0102X | Surgical Critical Care | 67945 | MN |
NPI | 1053653980 |
---|---|
Provider Name | Courtney Alyson Green |
First Address | Duluth, MN 55805-1951 |
Second Address | Rochester, MN 55905-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2013 |
Last Update Date | 10/11/2021 |