| Doctor Name: | VICTORIA LEOLA GREEN |
| NPI Number: | 1366586802 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 655 E Burkitt St Sheridan, WY - 828014401 |
| Business Phone Number: | 3076746343 |
| Business Fax Number: | |
| Mailing Address: | 655 E Burkitt St, SHERIDAN |
| State: | WY |
| Postal Code: | 828014401 |
| Phone Number: | 3076746343 |
| Fax Number: | |
| NPI Enumeration Date: | 02/17/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 385H00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WY |
| Taxonomy Type: | Respite Care Facility |
| Taxonomy Classification: | Respite Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |