Provider Demographics
NPI:1902592504
Name:PIERCE-GREEN, ELIZABETH SUE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SUE
Last Name:PIERCE-GREEN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29274 S SALO RD
Mailing Address - Street 2:
Mailing Address - City:MULINO
Mailing Address - State:OR
Mailing Address - Zip Code:97042-8734
Mailing Address - Country:US
Mailing Address - Phone:503-679-8713
Mailing Address - Fax:
Practice Address - Street 1:409 NW 2ND AVE STE A
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3517
Practice Address - Country:US
Practice Address - Phone:503-389-1500
Practice Address - Fax:503-212-4899
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200741941RN163WP0808X
OR10009162363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health