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General NPI Number Information
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NPI Number | 1043708381
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Entity Type | Individual
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Provider Name | AMBER GREENHOUSE
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Gender | Female
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Dates
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Enumeration Date | 04/23/2018
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Last Update Date | 04/23/2018
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Provider Practice Location Address
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Address Line | 1403 METRO DR STE C1
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3446
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Country | US
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Telephone | 318-625-7467
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Fax | 318-625-7420
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Provider Business Mailing Address
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Address Line | 1403 METRO DR STE C1
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3446
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Country | US
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Telephone | 318-625-7467
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Fax | 318-625-7420
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 20150229
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License Number State | LA
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