Provider Demographics
NPI:1659894129
Name:GREEN, NATALIE (CNA,MA)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:CNA,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2236 MARTIN AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70802-1428
Mailing Address - Country:US
Mailing Address - Phone:225-938-8577
Mailing Address - Fax:225-778-5759
Practice Address - Street 1:2236 MARTIN AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-1428
Practice Address - Country:US
Practice Address - Phone:225-938-8577
Practice Address - Fax:225-778-5759
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home