Healthcare Provider Details

I. General information

NPI: 1053157677
Provider Name (Legal Business Name): SARAH GREENE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 N UNIVERSITY DRIVE
JAMESTOWN ND
58405-0001
US

IV. Provider business mailing address

3820 MULLAN RD APT 201
MISSOULA MT
59808-5550
US

V. Phone/Fax

Practice location:
  • Phone: 701-252-3467
  • Fax:
Mailing address:
  • Phone: 360-710-9041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: