Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 48755 | KY |
Y | 2080P0208X | Pediatric Infectious Diseases | 48755 | KY |
NPI | 1073723086 |
---|---|
Provider Name | Julianne V Green |
First Address | Louisville, KY 40201-0909 |
Second Address | Louisville, KY 40202-3904 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 19/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201363510 | (05) | IN |
7100400880 | (05) | KY |