Sandra Green, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PN.0331410 Issued in CO

Practice address

1650 Cochrane Cir BLDG 2361
Fort Carson, CO 80913-4613

Phone

(719) 524-3715

NPI assigned

Sep 20, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1632096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632096000000",
    "number": "1558031583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4490 RAMBLEWOOD DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809206634",
            "telephone_number": "719-217-4544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 COCHRANE CIR BLDG 2361",
            "city": "FORT CARSON",
            "state": "CO",
            "postal_code": "809134613",
            "telephone_number": "719-524-3715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "SANDRA",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-20",
        "last_updated": "2021-09-20",
        "certification_date": "2021-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "CO",
            "license": "PN.0331410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://myaccess.dmdc.osd.mil/identitymanagement/authenticate.do?execution=e1s1",
            "affiliation": "Y",
            "affiliationName": "Department of Defense",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "GENESIS PATIENT PORTAL",
            "address_1": "1650 Cochrane Cir Bldg 2361",
            "city": "Fort Carson",
            "state": "CO",
            "country_code": "US",
            "postal_code": "809134613",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jordan Goslin, LCSW
• Blake D Graham, MD
• Ryan D Graham, PH.D.
• Eric H Grant, DO
• Lisa Marie Gray, DNP
• Sierra Green, DDS
• Diane Marie Greilich, M.D.
• Stacy L Griffin, RPH
• Artyom G Grigoryan, DDS
• Erin E Grillo, PT, DPT

• Licensed Practical Nurse in Fort Carson, CO
• Providers in Fort Carson, CO by specialty
• Licensed Practical Nurse in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.