Healthcare Provider Details

I. General information

NPI: 1184181570
Provider Name (Legal Business Name): LASHANNA GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2019
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 PLEASANT GROVE CT
DILLON SC
29536-7791
US

IV. Provider business mailing address

1010 PLEASANT GROVE CT
DILLON SC
29536-7791
US

V. Phone/Fax

Practice location:
  • Phone: 843-453-2696
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number228552
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26975
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: