Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 4301073070 | MI |
NPI | 1154313674 |
---|---|
Provider Name | Dr. Candace C Green |
First Address | Richland, WA 99352-4853 |
Second Address | Richland, WA 99352-4853 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 01/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0700410 | PHP (01) | MI |
1605910202 | BCBS (01) | MI |
4706056 | (05) | MI |
4706065 | (05) | MI |
4709343 | (05) | MI |
H49612 | (02) | MI |