Provider Demographics
NPI:1851988521
Name:WHITE-GREEN, LORA (BSN, RN)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:
Last Name:WHITE-GREEN
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:DE
Mailing Address - Zip Code:19708-0067
Mailing Address - Country:US
Mailing Address - Phone:215-681-5956
Mailing Address - Fax:302-595-4098
Practice Address - Street 1:203 CORNWELL DR
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-3103
Practice Address - Country:US
Practice Address - Phone:215-681-5956
Practice Address - Fax:302-595-4098
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0026676163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse