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General NPI Number Information
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NPI Number | 1649289091
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Entity Type | Individual
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Provider Name | LAKESHUR ROSHA GREEN FNP
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Gender | Female
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 03/30/2009
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Provider Practice Location Address
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Address Line | 2955 GULF FWY S
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City | LEAGUE CITY
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State | TX
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Zip | 77573-6750
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Country | US
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Telephone | 281-337-7351
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Fax | 281-534-4236
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Provider Business Mailing Address
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Address Line | 9 GREENWAY PLZ SUITE 2950
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City | HOUSTON
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State | TX
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Zip | 77046-0905
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Country | US
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Telephone | 713-580-9468
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Fax | 713-358-4801
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 658237
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License Number State | TX
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