Provider Demographics
NPI:1902850936
Name:GREEN, SEAN DAVID (MSN APRN FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:DAVID
Last Name:GREEN
Suffix:
Gender:M
Credentials:MSN APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7041 LEE PARK RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-3682
Mailing Address - Country:US
Mailing Address - Phone:804-746-3505
Mailing Address - Fax:804-730-8038
Practice Address - Street 1:7041 LEE PARK RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-3682
Practice Address - Country:US
Practice Address - Phone:804-746-3505
Practice Address - Fax:804-730-8038
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP113774363LF0000X
TX637990363LF0000X
VA0024178958363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D6170Medicare ID - Type Unspecified