MEDICARE: DONESHA GREEN

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	172V00000X	Community Health Worker	315190	TX

General Provider Information

NPI Number	:	1831580455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONESHA GREEN

Provider Business Mailing Address
First Line	:	4475 TRINITY MILLS RD
Second Line	:	#703523
City	:	DALLAS
State	:	TX
Zip	:	75370-0010
Country	:	US
Telephone Number	:	214-663-6599
Fax Number	:

Provider Business Practice Location Address
First Line	:	4475 TRINITY MILLS RD
Second Line	:	#703523
City	:	DALLAS
State	:	TX
Zip	:	75370-0010
Country	:	US
Telephone Number	:	214-663-6599
Fax Number	:

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

Provider Enumeration Date	:	02/18/2015
Last Update Date	:	02/18/2015

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Directions to “ DONESHA GREEN ” Practice Location

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