Provider Demographics
NPI:1568144798
Name:GREEN EVANS, DANA (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:
Last Name:GREEN EVANS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 WATSON TRL
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-7180
Mailing Address - Country:US
Mailing Address - Phone:318-455-3703
Mailing Address - Fax:
Practice Address - Street 1:635 WATSON TRL
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-7180
Practice Address - Country:US
Practice Address - Phone:318-455-3703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA215328363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily