Provider Demographics
NPI:1538393400
Name:GREEN, SANDRA A (APRN-CNS)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:A
Last Name:GREEN
Suffix:
Gender:F
Credentials:APRN-CNS
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 83
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:AR
Mailing Address - Zip Code:72422-0083
Mailing Address - Country:US
Mailing Address - Phone:870-857-3334
Mailing Address - Fax:870-857-9934
Practice Address - Street 1:1016 MCQUAY AVE
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455
Practice Address - Country:US
Practice Address - Phone:870-892-9949
Practice Address - Fax:870-892-0208
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARS002204364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health