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General NPI Number Information
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NPI Number | 1205510435
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Entity Type | Individual
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Provider Name | DEREK GREENWOOD APRN
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Gender | Male
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Dates
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Enumeration Date | 06/08/2023
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 310 S ROOSEVELT ST
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City | GOLDENDALE
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State | WA
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Zip | 98620-9201
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Country | US
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Telephone | 509-773-4022
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Fax |
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Provider Business Mailing Address
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Address Line | 630 HARMS RD
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City | CENTERVILLE
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State | WA
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Zip | 98613-2715
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Country | US
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Telephone | 831-512-2858
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 201905656RN
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 60666998
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP-70008596
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License Number State | WA
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