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General NPI Number Information
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NPI Number | 1922110691
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Entity Type | Individual
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Provider Name | AMY M GREEN CRNA
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/21/2016
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Provider Practice Location Address
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Address Line | 865 DESHONG DR
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City | PARIS
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State | TX
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Zip | 75460-9313
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Country | US
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Telephone | 903-785-4521
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Fax |
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Provider Business Mailing Address
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Address Line | 422 COUNTY ROAD 43400
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City | PARIS
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State | TX
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Zip | 75462-1625
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Country | US
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Telephone | 903-905-2143
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Fax |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN178273
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License Number State | GA
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