Provider Demographics
NPI:1205987047
Name:GREEN, AMBER STAR (APRN)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:STAR
Last Name:GREEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:STAR
Other - Last Name:PAWLIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1053 CENTER STREET
Mailing Address - Street 2:SC HOUSE CALLS INC
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169
Mailing Address - Country:US
Mailing Address - Phone:800-491-0909
Mailing Address - Fax:
Practice Address - Street 1:1053 CENTER STREET
Practice Address - Street 2:SC HOUSE CALLS INC
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169
Practice Address - Country:US
Practice Address - Phone:800-491-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333891363LF0000X
TN7443363LF0000X
SC3473363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC109194OtherSC RN MULTI-STATE LICENSE
TN111131OtherRN LICENSE #
TN3906732OtherXANTUS MEDICAID FOR TN
TN7443OtherAPN LICENSE
TN4031021OtherBLUE CROSS BLUE SHIELD
NYF333891-1OtherNURSE PRACTITIONER IN FAMILY HEALTH
NY533744-1OtherRN LICENSE
NYF333891OtherFNP LICENSE #
SC3473OtherAPRN FOR SC
NY533744OtherRN LICENSE #