Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN230432 | GA |
NPI | 1619520293 |
---|---|
Provider Name | Mrs. Wendy March Greenway |
First Address | Stockbridge, GA 30281-5085 |
Second Address | Stockbridge, GA 30281-5085 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2019 |
Last Update Date | 22/07/2019 |