Green, Alice

Green, Alice is an individual health care provider with primary practice located at 5 Good Samaritan Way , Mount Vernon IL 62864-2402. She recently has only one registered license in Dietary & Nutritional Service Providers / Dietitian, Registered, which is considered as her primary health care specialty. Green, Alice can be contacted via phone (916) 436-8300.

Contact Information

Primary practice address
5 Good Samaritan Way Mount Vernon IL 62864-2402
Phone: (916) 436-8300
Fax: (618) 436-6105
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dietary & Nutritional Service Providers / Dietitian, Registered 133V00000X

Profile Details

NPI number 1063059632
LBN Legal business name Green, Alice
Credentials Registered Dietitian (RD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 3rd, 2019
Last updated Dec 3rd, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063059632 NPPES
Illinois MEDICAID 164007727

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