Provider Demographics
NPI:1649289091
Name:GREEN, LAKESHUR ROSHA (FNP)
Entity type:Individual
Prefix:MRS
First Name:LAKESHUR
Middle Name:ROSHA
Last Name:GREEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9 GREENWAY PLZ
Mailing Address - Street 2:SUITE 2950
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-0905
Mailing Address - Country:US
Mailing Address - Phone:713-580-9468
Mailing Address - Fax:713-358-4801
Practice Address - Street 1:2955 GULF FWY S
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-6750
Practice Address - Country:US
Practice Address - Phone:281-337-7351
Practice Address - Fax:281-534-4236
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX658237363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y8552OtherBCBSTX PROVIDER NUMBER
8L8989OtherMEDICARE TPAN
8L8991OtherMEDICARE TPAN
8L8992OtherMEDICARE TPAN
8L8993OtherMEDICARE TPAN
8L8990OtherMEDICARE TPAN