Provider Demographics
NPI:1902122435
Name:GREEN, LORI TERESA (RN)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:TERESA
Last Name:GREEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:LORI
Other - Middle Name:TERESA
Other - Last Name:LALONDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:109 FORD ST
Mailing Address - Street 2:OMHC
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-1419
Mailing Address - Country:US
Mailing Address - Phone:315-394-0101
Mailing Address - Fax:315-394-0097
Practice Address - Street 1:109 FORD ST
Practice Address - Street 2:OMHC
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-1419
Practice Address - Country:US
Practice Address - Phone:315-394-0101
Practice Address - Fax:315-394-0097
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY490224163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult