Healthcare Provider Details

I. General information

NPI: 1467635102
Provider Name (Legal Business Name): DELORIS DIAN GREEN ROBINSON NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 NORTH ELM STREET SUITE 206
WESTFIELD MA
01085
US

IV. Provider business mailing address

320 RIVERSIDE DRIVE
FLORENCE MA
01062
US

V. Phone/Fax

Practice location:
  • Phone: 413-536-8777
  • Fax: 413-536-3161
Mailing address:
  • Phone: 413-586-2016
  • Fax: 413-586-0212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number131976
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: