Provider Demographics
NPI:1861137226
Name:GREEN, CHRISTINA LOIS (LPN)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LOIS
Last Name:GREEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 ROANE STATE HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37854-4333
Mailing Address - Country:US
Mailing Address - Phone:865-304-9737
Mailing Address - Fax:
Practice Address - Street 1:5525 ROANE STATE HWY
Practice Address - Street 2:
Practice Address - City:ROCKWOOD
Practice Address - State:TN
Practice Address - Zip Code:37854-4333
Practice Address - Country:US
Practice Address - Phone:865-304-9737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-30
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000071877251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care