Provider Demographics
NPI:1033419767
Name:FT LEONARD WOOD WTU
Entity Type:Organization
Organization Name:FT LEONARD WOOD WTU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN NURSE CASE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:GREENWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:573-586-0179
Mailing Address - Street 1:29690 MONROE ROAD 307
Mailing Address - Street 2:
Mailing Address - City:SHELBINA
Mailing Address - State:MO
Mailing Address - Zip Code:63468-2403
Mailing Address - Country:US
Mailing Address - Phone:573-586-0179
Mailing Address - Fax:
Practice Address - Street 1:BLD 312 ROOM 12
Practice Address - Street 2:
Practice Address - City:FT LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473
Practice Address - Country:US
Practice Address - Phone:573-586-0179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO137163286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital