Individual
LAURA LESLIE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2030 SUTTER PL, DAVIS, CA 95616-6212
(530) 750-5904
(530) 750-5905
Mailing address
P.O. BOX 255228, SACRAMENTO, CA 95865-5228
(800) 470-0071
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP6252
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RN391706
—
CA
Enumeration date
09/21/2006
Last updated
04/24/2012
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