Provider Demographics
NPI:1104045756
Name:GREENWOOD, SUZANNE L
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:L
Last Name:GREENWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SHERMAN LN
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74604-5723
Mailing Address - Country:US
Mailing Address - Phone:580-762-8647
Mailing Address - Fax:580-762-8070
Practice Address - Street 1:2507 WINDSOR RD
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1642
Practice Address - Country:US
Practice Address - Phone:580-762-3875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide