Provider Demographics
NPI:1245770957
Name:GREENWOOD, BROOKLYN
Entity Type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:
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 1:321 STONECREEK CIR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:AL
Mailing Address - Zip Code:35080-8109
Mailing Address - Country:US
Mailing Address - Phone:205-240-3459
Mailing Address - Fax:
Practice Address - Street 1:321 STONECREEK CIR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AL
Practice Address - Zip Code:35080-8109
Practice Address - Country:US
Practice Address - Phone:205-240-3459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-125189363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner