Healthcare Provider Details

I. General information

NPI: 1194331470
Provider Name (Legal Business Name): CLARA DORNISHA GREEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 N ARLINGTON AVE STE 335
RENO NV
89503-4460
US

IV. Provider business mailing address

1155 MILL ST
RENO NV
89502-1576
US

V. Phone/Fax

Practice location:
  • Phone: 775-770-6230
  • Fax:
Mailing address:
  • Phone: 775-982-5262
  • Fax: 775-982-4196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number868766
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP146179
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: