Provider Demographics
NPI:1164779013
Name:GREENWOOD, CAROL JEANE (RN)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:JEANE
Last Name:GREENWOOD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4108
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86340-4108
Mailing Address - Country:US
Mailing Address - Phone:928-300-2683
Mailing Address - Fax:
Practice Address - Street 1:40 WINDSONG DR
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-4436
Practice Address - Country:US
Practice Address - Phone:928-300-2863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN085778163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse