Healthcare Provider Details

I. General information

NPI: 1831058155
Provider Name (Legal Business Name): ERIN MARIE GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 ARROWOOD DR
SANTA ROSA CA
95407-7503
US

IV. Provider business mailing address

4415 SONOMA HWY STE B
SANTA ROSA CA
95409-4165
US

V. Phone/Fax

Practice location:
  • Phone: 707-565-3495
  • Fax:
Mailing address:
  • Phone: 707-327-0909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: