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NPI Code Detail

MEDICARE: MR. GLENFORD U GREENAWAY

MEDICARE: MR. GLENFORD U GREENAWAY
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN-NP296673GA
2390200000XStudent in an Organized Health Care Education/Training ProgramGA

General Provider Information

NPI Number : 1720836943
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GLENFORD U GREENAWAY
Provider Business Mailing Address
First Line : 100 WASHINGTON AVE S STE 1210
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55401-2511
Country : US
Telephone Number : 866-492-5336
Fax Number :
Provider Business Practice Location Address
First Line : 100 WASHINGTON AVE S STE 1210
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55401-2511
Country : US
Telephone Number : 866-492-5336
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2024
Last Update Date : 11/10/2025

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Directions to “ MR. GLENFORD U GREENAWAY ” Practice Location

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