Provider Demographics
NPI:1063061497
Name:GREEN, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:NASH
Mailing Address - State:OK
Mailing Address - Zip Code:73761-0041
Mailing Address - Country:US
Mailing Address - Phone:580-278-9262
Mailing Address - Fax:
Practice Address - Street 1:312 N VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-4500
Practice Address - Country:US
Practice Address - Phone:888-573-7792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator