Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 637307 | TX |
NPI | 1043425978 |
---|---|
Provider Name | Dorothy Laverne Green |
First Address | Corpus Christi, TX 78418-6322 |
Second Address | Corpus Christi, TX 78418-6322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 13/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8J7681 | (02) | TX |