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NPI Code Detail

MEDICARE: MR. DANIEL NICK GREEN RN

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
1163W00000XRegistered Nurse71606LA

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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