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NPI Code Detail

MEDICARE: MYRANDA GREENWOOD NP

MEDICARE: MYRANDA GREENWOOD NP
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
1363LF0000XFamily Nurse Practitioner209020264IL

General Provider Information

NPI Number : 1205479961
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYRANDA GREENWOOD NP
Provider Business Mailing Address
First Line : 363 N WEST ST
Second Line :
City : OLNEY
State : IL
Zip : 62450-1160
Country : US
Telephone Number : 618-392-1140
Fax Number : 618-392-4778
Provider Business Practice Location Address
First Line : 363 N WEST ST
Second Line :
City : OLNEY
State : IL
Zip : 62450-1160
Country : US
Telephone Number : 618-392-1140
Fax Number : 618-392-4778
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2019
Last Update Date : 05/06/2026

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