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General NPI Number Information
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NPI Number | 1245574516
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Entity Type | Organization
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Legal Business Name | TRINA L. GREENWALD LLC
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Dates
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Enumeration Date | 11/26/2012
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | 515 N BRADNER AVE
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City | MARION
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State | IN
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Zip | 46952-2449
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Country | US
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Telephone | 765-664-8000
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Fax | 877-731-2066
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Provider Business Mailing Address
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Address Line | 515 N BRADNER AVE
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City | MARION
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State | IN
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Zip | 46952-2449
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Country | US
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Telephone | 765-664-8000
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Fax |
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Authorized Official
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Title or Position | OWNER/PRACTITIONER
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Name | TRINA L GREENWALD
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Credential | FNP-C, PMHNP-BC
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Telephone | 765-664-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 71002182A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 28084011A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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