Provider Demographics
NPI:1083868582
Name:GREENE, SARAH R (CRNP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:R
Last Name:GREENE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PLAZA CT STE C
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8258
Mailing Address - Country:US
Mailing Address - Phone:570-421-3800
Mailing Address - Fax:
Practice Address - Street 1:100 PLAZA CT STE C
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8258
Practice Address - Country:US
Practice Address - Phone:570-421-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009993363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025366570001Medicaid
152909Medicare PIN