1649289091 NPI number — MRS. LAKESHUR ROSHA GREEN FNP

Table of content: MRS. LAKESHUR ROSHA GREEN FNP (NPI 1649289091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649289091 NPI number — MRS. LAKESHUR ROSHA GREEN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREEN
Provider First Name:
LAKESHUR
Provider Middle Name:
ROSHA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
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:
1649289091
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 GREENWAY PLZ
Provider Second Line Business Mailing Address:
SUITE 2950
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77046-0905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-580-9468
Provider Business Mailing Address Fax Number:
713-358-4801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2955 GULF FWY S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEAGUE CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77573-6750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-337-7351
Provider Business Practice Location Address Fax Number:
281-534-4236
Provider Enumeration Date:
08/05/2006

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: 363LF0000X , with the licence number:  658237 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8Y8552 . This is a "BCBSTX PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8L8989 . This is a "MEDICARE TPAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8L8991 . This is a "MEDICARE TPAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8L8992 . This is a "MEDICARE TPAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8L8993 . This is a "MEDICARE TPAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8L8990 . This is a "MEDICARE TPAN" identifier . This identifiers is of the category "OTHER".




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