Healthcare Provider Details

I. General information

NPI: 1619381654
Provider Name (Legal Business Name): AMY ERIN GREENHAW ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N THOMPSON AVE
NIPOMO CA
93444-9086
US

IV. Provider business mailing address

534 ADINA WAY
NIPOMO CA
93444-5621
US

V. Phone/Fax

Practice location:
  • Phone: 805-235-2306
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: