Provider Demographics
NPI:1780649228
Name:GRYNWALD, ANA (ARNP)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:GRYNWALD
Suffix:
Gender:F
Credentials:ARNP
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 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-272-5100
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:200 E CHESTNUT ST STE 303
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1831
Practice Address - Country:US
Practice Address - Phone:502-629-5552
Practice Address - Fax:502-629-3132
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV60951363LF0000X
KY5401P363LF0000X
KY3005401363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001426Medicaid
KY000000662212OtherANTHEM - NIS
KY5267182OtherCIGNA - NIS
P00471692OtherRAIL ROAD MEDICARE
IN201048040Medicaid
KY000052153KOtherHUMANA - NIS
KY114969OtherSIHO - NIS
OH2519788Medicaid
KY000000534400OtherBCBS
KY50035741OtherPASSPORT - NIS
KY78012929Medicaid
WVQ28258Medicare UPIN
IN201048040Medicaid
KYP400016131Medicare PIN
KY78012929Medicaid