Provider Demographics
NPI:1962930636
Name:GREENE, SANDRA CAROLINE (FNP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:CAROLINE
Last Name:GREENE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11958 SW GARDEN PL
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8248
Mailing Address - Country:US
Mailing Address - Phone:916-271-7445
Mailing Address - Fax:
Practice Address - Street 1:3001 DOUGLAS BLVD STE 325
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4289
Practice Address - Country:US
Practice Address - Phone:916-241-9844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006020363L00000X
OR202101910NP-PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner