Provider Demographics
NPI:1598413304
Name:GREEN, SIERRA N (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:N
Last Name:GREEN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8558 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7032
Mailing Address - Country:US
Mailing Address - Phone:193-927-0842
Mailing Address - Fax:219-703-6854
Practice Address - Street 1:800 MACARTHUR BLVD STE 5
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2917
Practice Address - Country:US
Practice Address - Phone:219-392-7025
Practice Address - Fax:219-392-7026
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71012595A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health