Provider Demographics
NPI:1396202255
Name:GREENWELL, NEVIA A (LPAT)
Entity Type:Individual
Prefix:MRS
First Name:NEVIA
Middle Name:A
Last Name:GREENWELL
Suffix:
Gender:F
Credentials:LPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-4325
Mailing Address - Country:US
Mailing Address - Phone:502-479-4654
Mailing Address - Fax:
Practice Address - Street 1:1949 GOLDSMITH LN STE 103
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3096
Practice Address - Country:US
Practice Address - Phone:502-819-6720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY161868221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist