Provider Demographics
NPI:1669943932
Name:GREEN, MARIAN ELIZABETH (APRN)
Entity type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:ELIZABETH
Last Name:GREEN
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 AYLESBURY DR.
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608
Mailing Address - Country:US
Mailing Address - Phone:757-897-4845
Mailing Address - Fax:
Practice Address - Street 1:628 AYLESBURY DR.
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608
Practice Address - Country:US
Practice Address - Phone:757-897-4845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024192051363LP0808X
VA0001130852163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse