Healthcare Provider Details

I. General information

NPI: 1710023007
Provider Name (Legal Business Name): DEBORAH GREEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 TOWER DR STE 304
MONROE LA
71201-5783
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 318-966-6320
  • Fax: 318-966-6321
Mailing address:
  • Phone: 318-966-6320
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP03448
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP03448
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: