Healthcare Provider Details

I. General information

NPI: 1932045606
Provider Name (Legal Business Name): MONICA GREENE DHA, RN, BSN, MLT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 BENTON RD STE 500
BOSSIER CITY LA
71111-4195
US

IV. Provider business mailing address

1907 BENTON RD STE 500
BOSSIER CITY LA
71111-4195
US

V. Phone/Fax

Practice location:
  • Phone: 318-304-8151
  • Fax: 318-304-8152
Mailing address:
  • Phone: 318-304-8151
  • Fax: 318-304-8152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License NumberCLP.201635-TCH
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number233756
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: