Healthcare Provider Details

I. General information

NPI: 1073373429
Provider Name (Legal Business Name): LAURA GREEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2024
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5618 PEOPLES AVE
NEW ORLEANS LA
70122-6319
US

IV. Provider business mailing address

5618 PEOPLES AVE
NEW ORLEANS LA
70122-6319
US

V. Phone/Fax

Practice location:
  • Phone: 904-881-1783
  • Fax:
Mailing address:
  • Phone: 904-881-1783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: