Provider Demographics
NPI:1366827339
Name:GREEN, EMILY ANDREA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANDREA
Last Name:GREEN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 S 30TH ST
Mailing Address - Street 2:APARTMENT 245
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-3246
Mailing Address - Country:US
Mailing Address - Phone:360-713-2726
Mailing Address - Fax:
Practice Address - Street 1:655 NW RICHMOND BEACH RD
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177-3121
Practice Address - Country:US
Practice Address - Phone:206-542-9688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60580146363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily