NPI 1386107308 · live from the CMS NPI Registry
Priscilla Jo Green, RD
Dietitian, Registered in Los Cerrillos, NM. National Provider Identifier 1386107308, active.
NPI record
| NPI | 1386107308 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 351 Red Rock Road, Los Cerrillos, NM 87010 |
| Practice phone | 505-274-8939 |
| Mailing address | Hc 63 Box 30, Pena Blanca, NM 87041 |
| Enumerated | April 8, 2019 |
| Last updated | June 11, 2019 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered primary | 133V00000X | LD-0653 (NM) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.