Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 30017 | OK |
N | 207V00000X | Obstetrician & Gynecologist | 35.139668 | OH |
Y | 207VX0201X | Gynecologic Oncologist | 200046663 | MO |
NPI | 1235574401 |
---|---|
Provider Name | Molly Greenwade |
First Address | Springfield, MO 65808-9007 |
Second Address | Springfield, MO 65807-5292 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2013 |
Last Update Date | 17/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200046663 | (05) | MO |