Provider Demographics
NPI:1770927238
Name:GREEN, ALLISON SIDES (RN)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:SIDES
Last Name:GREEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 GREENPOND RD
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:SC
Mailing Address - Zip Code:29388-8873
Mailing Address - Country:US
Mailing Address - Phone:864-476-7035
Mailing Address - Fax:
Practice Address - Street 1:710 CROSS ANCHOR RD
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:SC
Practice Address - Zip Code:29388-2301
Practice Address - Country:US
Practice Address - Phone:864-476-7045
Practice Address - Fax:864-476-7224
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC51324163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool