Provider Demographics
NPI:1124123237
Name:GREEN, DONNA J (NP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:GREEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9991 MARSH LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-1766
Mailing Address - Country:US
Mailing Address - Phone:214-358-0090
Mailing Address - Fax:214-358-0760
Practice Address - Street 1:9991 MARSH LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-1766
Practice Address - Country:US
Practice Address - Phone:214-358-0090
Practice Address - Fax:214-358-0760
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX582607363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192769101Medicaid
TX192769101Medicaid
TXS88077Medicare UPIN
TX8K5774Medicare PIN