Provider Demographics
NPI:1043425978
Name:GREEN, DOROTHY LAVERNE (APRN-BC)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:LAVERNE
Last Name:GREEN
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:L
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITION
Mailing Address - Street 1:13925 BLACKBEARD DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-6322
Mailing Address - Country:US
Mailing Address - Phone:361-537-7909
Mailing Address - Fax:
Practice Address - Street 1:13925 BLACKBEARD DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-6322
Practice Address - Country:US
Practice Address - Phone:361-537-7909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX637307363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J7681Medicare UPIN