Provider Demographics
NPI:1710409495
Name:GREEN, ERICA LAUREN MILLER (DNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LAUREN MILLER
Last Name:GREEN
Suffix:
Gender:F
Credentials:DNP, PMHNP
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:LAUREN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9400 ZANE AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1814
Mailing Address - Country:US
Mailing Address - Phone:763-762-8800
Mailing Address - Fax:
Practice Address - Street 1:6363 FRANCE AVE S
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2129
Practice Address - Country:US
Practice Address - Phone:952-903-1265
Practice Address - Fax:952-922-2525
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5293363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health