Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | A003811 | AR |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | A003811 | AR |
N | 363LG0600X | Nurse Practitioner - Gerontology | A003811 | AR |
NPI | 1215278163 |
---|---|
Provider Name | Mrs. Ebonye N Green |
First Address | Benton, AR 72019-9098 |
Second Address | Little Rock, AR 72205-7101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2013 |
Last Update Date | 01/03/2013 |