Individual
NYEKAZI GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
392 MANSFIELD DR, SLIDELL, LA 70458-7318
(504) 481-6652
(985) 605-7228
Mailing address
392 MANSFIELD DR, SLIDELL, LA 70458-7318
(504) 481-6652
(985) 605-7228
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
172A00000X
Driver
—
—
172V00000X
Community Health Worker
—
—
372600000X
Adult Companion
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/12/2016
Last updated
05/04/2017
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