Provider Demographics
NPI:1043425978
Name:GREEN, DOROTHY LAVERNE (APRN-BC)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:LAVERNE
Last Name:GREEN
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:L
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITION
Mailing Address - Street 1:7010 TREE TOP PL
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-4316
Mailing Address - Country:US
Mailing Address - Phone:361-537-7909
Mailing Address - Fax:855-710-7060
Practice Address - Street 1:5959 S STAPLES ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3846
Practice Address - Country:US
Practice Address - Phone:361-537-7909
Practice Address - Fax:855-710-7060
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP115841363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J7681Medicare UPIN