Individual provider · Type 1 NPI

Ethan Thomas Green

Nurse Practitioner · Grand Rapids, MI

NPI number 1609547702 Active

Practice location

300 68th St SE
Grand Rapids, MI 49548-6927

Call (616) 455-5000 Map

Fax (616) 281-6459

Specialties and licenses

TaxonomyCodeLicense
Nurse Practitioner Primary 363L00000X4704318670 (MI)

Nurse Practitioner: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance wit…

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About NPI 1609547702

Ethan Thomas Green's National Provider Identifier is 1609547702, issued on Sep 28, 2021. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Grand Rapids, MI. The record was last updated on Oct 3, 2021.