Provider Demographics
NPI:1467635102
Name:GREEN ROBINSON, DELORIS DIAN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:DELORIS
Middle Name:DIAN
Last Name:GREEN ROBINSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 RIVERSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062
Mailing Address - Country:US
Mailing Address - Phone:413-586-2016
Mailing Address - Fax:413-586-0212
Practice Address - Street 1:94 NORTH ELM STREET
Practice Address - Street 2:SUITE 206
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085
Practice Address - Country:US
Practice Address - Phone:413-536-8777
Practice Address - Fax:413-536-3161
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA131976363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care