Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 28983 | KY |
Y | 2080P0204X | Pediatric Emergency Doctor | 28983 | KY |
NPI | 1063577997 |
---|---|
Provider Name | Leslie A. Greenwell |
First Address | Chicago, IL 60677-6879 |
Second Address | Louisville, KY 40202-1821 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 03/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100383160 | (05) | IN |
64289838 | (05) | KY |
F76797 | (02) | KY |