NPI 1114297660

Janiel J Green, PAC

Practitioner Medical Physician Assistant Rexburg, ID

Practice location

Address: 36 Professional Plz Suite #102, Rexburg, ID 83440-2049
Phone: (208) 356-0234
Fax: (208) 656-8444

Registered specialties

Medical Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363AM0700X Licence PA-957 (ID)

Other Physician Assistant providers in Idaho →

Registry record

NPI: 1114297660
Entity type: Individual
Sex (as registered): Female
NPI issued: 30 Dec 2011
Record last updated: 30 Dec 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.