MEDICARE: MATTHEW GREENWOOD APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	54474	NM

General Provider Information

NPI Number	:	1033680566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW GREENWOOD APRN

Provider Business Mailing Address
First Line	:	PO BOX 26666
Second Line	:	PROVIDER ENROLLMENT
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87125-6666
Country	:	US
Telephone Number	:	505-923-6770
Fax Number	:	505-923-5354

Provider Business Practice Location Address
First Line	:	4901 LANG AVE NE STE 203
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-4597
Country	:	US
Telephone Number	:	505-982-3113
Fax Number	:	505-982-2462

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2018
Last Update Date	:	04/15/2019

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