Healthcare Provider Details

I. General information

NPI: 1497246284
Provider Name (Legal Business Name): SARAH ELIZABETH GREEN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CHESTNUT ST FL 11
PHILADELPHIA PA
19107-3612
US

IV. Provider business mailing address

1101 MARKET ST STE 2720
PHILADELPHIA PA
19107-2934
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-7785
  • Fax: 215-955-9362
Mailing address:
  • Phone: 215-955-7785
  • Fax: 215-955-9362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number26NR18914600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00828900
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP018702
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: