1437586096 NPI number — ANGELLA MARIE GREENWOOD APN, FNP, BC

Table of content: ANGELLA MARIE GREENWOOD APN, FNP, BC (NPI 1437586096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437586096 NPI number — ANGELLA MARIE GREENWOOD APN, FNP, BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREENWOOD
Provider First Name:
ANGELLA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN, FNP, BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALVARADO
Provider Other First Name:
ANGELLA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APN,FNP,BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437586096
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
309 S. MCCOY ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-339-6245
Provider Business Mailing Address Fax Number:
815-339-2617

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
309 S MCCOY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61326-9333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-339-6245
Provider Business Practice Location Address Fax Number:
815-339-2617
Provider Enumeration Date:
09/27/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  209.010726 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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