Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ethan Thomas Green

Individual provider Nurse Practitioner · NPI 1609547702

Ethan Thomas Green is a Nurse Practitioner in Grand Rapids, Michigan. Qualified in 2021, 5 years ago. Practices with Pine Rest Christian Mental Health Services, a 353-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Michigan.

Years since qualifying
5
Licensed in
MI
In the registry since
2021
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Practice location Address checks out

300 68th St SE
Grand Rapids, MI 49548-6927
Phone: (616) 455-5000
Fax: (616) 281-6459
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 4704318670 (MI)

Record details

NPI number1609547702
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedSeptember 28, 2021
Last updated in NPPESOctober 3, 2021
Certification dateOctober 3, 2021
Mailing address300 68th St Se, Grand Rapids, MI 49548-6927

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Pine Rest Christian Mental Health Services — 353 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Grand Rapids