Healthcare Provider Details

I. General information

NPI: 1093678658
Provider Name (Legal Business Name): DANA MARIE GREENWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 WALES ST
SCRANTON PA
18508-1331
US

IV. Provider business mailing address

625 WALES ST
SCRANTON PA
18508-1331
US

V. Phone/Fax

Practice location:
  • Phone: 570-407-2783
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP034548
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: