| Doctor Name: | MRS. MICHELLE RENAE GREEN |
| NPI Number: | 1174729818 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 5601005008 |
| Business Practice Address: | 124 Ames St Elk Rapids, MI - 496299449 |
| Business Phone Number: | 2312648282 |
| Business Fax Number: | 2312646655 |
| Mailing Address: | Po Box 851, ELK RAPIDS |
| State: | MI |
| Postal Code: | 496290851 |
| Phone Number: | 2312648282 |
| Fax Number: | 2312646655 |
| NPI Enumeration Date: | 06/21/2007 |
| NPI Last Update Date: | 01/10/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 5601005008 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |