Healthcare Provider Details

I. General information

NPI: 1023773561
Provider Name (Legal Business Name): KRISTEN SUZANNE GREEN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 OMEGA DR BLDG B STE 86
NEWARK DE
19713-2059
US

IV. Provider business mailing address

405 SILVERSIDE RD STE 111
WILMINGTON DE
19809-1768
US

V. Phone/Fax

Practice location:
  • Phone: 302-738-5500
  • Fax: 302-738-9449
Mailing address:
  • Phone: 302-798-0666
  • Fax: 302-798-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0011705
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0048860
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: