Provider Demographics
NPI:1417730847
Name:GREEN-BARKSDALE, SABRINA NICOLE (LPN)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:NICOLE
Last Name:GREEN-BARKSDALE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SABRINA
Other - Middle Name:NICOLE
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14231 AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-2894
Mailing Address - Country:US
Mailing Address - Phone:313-899-0092
Mailing Address - Fax:
Practice Address - Street 1:14231 AUBURN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-2894
Practice Address - Country:US
Practice Address - Phone:313-899-0092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703090664164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse