Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | AP129866 | TX |
NPI | 1003278615 |
---|---|
Provider Name | Donna Green |
First Address | Arlington, TX 76010 |
Second Address | Arlington, TX 76010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2016 |
Last Update Date | 23/03/2016 |