Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 54474 | NM |
NPI | 1033680566 |
---|---|
Provider Name | Matthew Greenwood |
First Address | Albuquerque, NM 87125-6666 |
Second Address | Albuquerque, NM 87109-4597 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2018 |
Last Update Date | 15/04/2019 |