Provider Demographics
NPI:1326011479
Name:GREEN, CARRIE LYNN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:LYNN
Last Name:GREEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 821
Mailing Address - Street 2:
Mailing Address - City:UTOPIA
Mailing Address - State:TX
Mailing Address - Zip Code:78884-0821
Mailing Address - Country:US
Mailing Address - Phone:830-966-2455
Mailing Address - Fax:830-966-2455
Practice Address - Street 1:1100 WILFORD HALL LOOP,BLDG 4554 ATTN: 59 MDW/SGHC
Practice Address - Street 2:
Practice Address - City:JBSA LACKLAND, TX
Practice Address - State:TX
Practice Address - Zip Code:78236-9908
Practice Address - Country:US
Practice Address - Phone:210-292-5596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX550629367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered