1467635102 NPI number — MS. DELORIS DIAN GREEN ROBINSON NURSE PRACTITIONER

Table of content: MS. DELORIS DIAN GREEN ROBINSON NURSE PRACTITIONER (NPI 1467635102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467635102 NPI number — MS. DELORIS DIAN GREEN ROBINSON NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREEN ROBINSON
Provider First Name:
DELORIS
Provider Middle Name:
DIAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467635102
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 RIVERSIDE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-586-2016
Provider Business Mailing Address Fax Number:
413-586-0212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
94 NORTH ELM STREET
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
WESTFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-536-8777
Provider Business Practice Location Address Fax Number:
413-536-3161
Provider Enumeration Date:
12/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X , with the licence number:  131976 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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