Healthcare Provider Details

I. General information

NPI: 1356726152
Provider Name (Legal Business Name): LORI ANN GREEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 TIMBER FALL CT SUITE B
EUREKA CA
95503-4892
US

IV. Provider business mailing address

2185 PACHECO ST
CONCORD CA
94520-2309
US

V. Phone/Fax

Practice location:
  • Phone: 707-442-5700
  • Fax: 707-441-1000
Mailing address:
  • Phone: 925-676-0300
  • Fax: 925-676-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number454142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: