Provider Demographics
NPI:1558525576
Name:GREEN, DONNA JEAN
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:JEAN
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 BAILEY DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-6205
Mailing Address - Country:US
Mailing Address - Phone:972-217-9159
Mailing Address - Fax:972-230-6823
Practice Address - Street 1:139 BAILEY DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-6205
Practice Address - Country:US
Practice Address - Phone:972-217-9159
Practice Address - Fax:972-230-6823
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care