Healthcare Provider Details

I. General information

NPI: 1891289781
Provider Name (Legal Business Name): MRS. LOURDES GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 CHEROKEE ST
DENVER CO
80204-3632
US

IV. Provider business mailing address

777 BANNOCK ST
DENVER CO
80204-4597
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-3500
  • Fax: 303-436-3520
Mailing address:
  • Phone: 303-436-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0116739
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: