Provider Demographics
NPI:1962855726
Name:GREEN, KRISTEN ELIZABETH (CNM)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:ELIZABETH
Last Name:GREEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 PENNSYLVANIA AVE NW FL 5
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-3201
Mailing Address - Country:US
Mailing Address - Phone:202-741-2500
Mailing Address - Fax:202-741-2550
Practice Address - Street 1:2150 PENNSYLVANIA AVE NW FL 5
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-3201
Practice Address - Country:US
Practice Address - Phone:202-741-2500
Practice Address - Fax:202-741-2550
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8839367A00000X
DCRN1062312367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife