MEDICARE: MR. DANIEL NICK GREEN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	71606	LA

General Provider Information

NPI Number	:	1679547681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL NICK GREEN RN

Provider Business Mailing Address
First Line	:	9282 LYTHAM DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-4834
Country	:	US
Telephone Number	:	318-688-5112
Fax Number	:

Provider Business Practice Location Address
First Line	:	9282 LYTHAM DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-4834
Country	:	US
Telephone Number	:	318-688-5112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	07/08/2007

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