1881050771 NPI number — MS. U'DANA LYNELL GREEN MA, CI 5108

Table of content: MS. U'DANA LYNELL GREEN MA, CI 5108 (NPI 1881050771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881050771 NPI number — MS. U'DANA LYNELL GREEN MA, CI 5108

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREEN
Provider First Name:
U'DANA
Provider Middle Name:
LYNELL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, CI 5108
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GREEN
Provider Other First Name:
U'DANA
Provider Other Middle Name:
LYNELL
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
I
Provider Other Credential Text:
MA, CI 5108
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1881050771
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5555 BEECHWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70805-1806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-341-3568
Provider Business Mailing Address Fax Number:
225-341-3569

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5555 BEECHWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70805-1806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-341-3568
Provider Business Practice Location Address Fax Number:
225-341-3569
Provider Enumeration Date:
01/07/2016

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com