Provider Demographics
NPI:1437586096
Name:GREENWOOD, ANGELLA MARIE (APN, FNP, BC)
Entity Type:Individual
Prefix:
First Name:ANGELLA
Middle Name:MARIE
Last Name:GREENWOOD
Suffix:
Gender:F
Credentials:APN, FNP, BC
Other - Prefix:
Other - First Name:ANGELLA
Other - Middle Name:MARIE
Other - Last Name:ALVARADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN,FNP,BC
Mailing Address - Street 1:309 S. MCCOY ST.
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61326
Mailing Address - Country:US
Mailing Address - Phone:815-339-6245
Mailing Address - Fax:815-339-2617
Practice Address - Street 1:309 S MCCOY ST
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61326-9333
Practice Address - Country:US
Practice Address - Phone:815-339-6245
Practice Address - Fax:815-339-2617
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.010726363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily