Provider Demographics
NPI:1982950523
Name:GREEN, LOUIS S (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:S
Last Name:GREEN
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 NW 95TH TER
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7317
Mailing Address - Country:US
Mailing Address - Phone:954-804-5561
Mailing Address - Fax:954-796-5893
Practice Address - Street 1:259 NW 95TH TER
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-7317
Practice Address - Country:US
Practice Address - Phone:954-804-5561
Practice Address - Fax:954-796-5893
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3199112163W00000X, 372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No372500000XNursing Service Related ProvidersChore Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3199112OtherFLORIDA RN LICENSE #