Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | MD-21050 | HI |
NPI | 1023458700 |
---|---|
Provider Name | Jessica Green |
First Address | Honolulu, HI 96813-3097 |
Second Address | Honolulu, HI 96813-3097 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2013 |
Last Update Date | 01/10/2020 |