Provider Demographics
NPI:1164992038
Name:GREER, SANDRA S (NP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:S
Last Name:GREER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:G
Other - Last Name:SASSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7944 JASONS LANDING WAY
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-2664
Mailing Address - Country:US
Mailing Address - Phone:215-880-0986
Mailing Address - Fax:
Practice Address - Street 1:4660 WILKENS AVE STE 100
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-4899
Practice Address - Country:US
Practice Address - Phone:410-247-0782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR203466363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1164992038Medicaid