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NPI Code Detail

MEDICARE: SIERRA GREENWADE

MEDICARE: SIERRA GREENWADE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner3010900KY

General Provider Information

NPI Number : 1679010466
Entity Type Code : Individual
Provider Name (Legal Business Name) : SIERRA GREENWADE
Provider Business Mailing Address
First Line : 411 W 13TH ST
Second Line :
City : HOPKINSVILLE
State : KY
Zip : 42240-2027
Country : US
Telephone Number : 270-305-2628
Fax Number :
Provider Business Practice Location Address
First Line : 1739 CANTON ST
Second Line :
City : HOPKINSVILLE
State : KY
Zip : 42240-1991
Country : US
Telephone Number : 270-881-1411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2017
Last Update Date : 03/17/2018

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Directions to “ SIERRA GREENWADE ” Practice Location

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