Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 921 | IL |
N | 207Q00000X | Family Doctor | 2012022304 | MO |
NPI | 1568727600 |
---|---|
Provider Name | Dr. Shana Alexandra Greven |
First Address | Lynchburg, VA 24502-2101 |
Second Address | Lynchburg, VA 24502-2101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2012 |
Last Update Date | 10/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0102205830 | VIRGINIA LICENSE NUMBER (01) | VA |
2012022304 | MISSOURI LICENSE NUMBER (01) | MO |