Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP145992 | TX |
N | 363LC1500X | Nurse Practitioner - Community Health | 53135-1214 | LA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | APO1214 | LA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | CNP02366 | NM |
N | 363LG0600X | Nurse Practitioner - Gerontology | APO1214 | LA |
N | 363LP2300X | Nurse Practitioner - Primary Care | APO1214 | LA |
NPI | 1538141221 |
---|---|
Provider Name | Ms. Lynda Ann Green |
First Address | Gorman, TX 76454 |
Second Address | Cedar Crest, NM 87008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 09/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
82688028 | (05) | NM |
R14831 | (02) |