Healthcare Provider Details

I. General information

NPI: 1861249252
Provider Name (Legal Business Name): KATRINA GREENWALT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2024
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 WABASHA ST S
SAINT PAUL MN
55107-1805
US

IV. Provider business mailing address

640 JACKSON ST
SAINT PAUL MN
55101-2595
US

V. Phone/Fax

Practice location:
  • Phone: 952-853-8800
  • Fax:
Mailing address:
  • Phone: 651-254-3456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number83034
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: