Provider Demographics
NPI:1821406943
Name:GREYWOLF PSYCHIATRY SERVICES, INC
Entity Type:Organization
Organization Name:GREYWOLF PSYCHIATRY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:GREYWOLF
Authorized Official - Suffix:
Authorized Official - Credentials:DNP-PMHNP, BC
Authorized Official - Phone:603-380-4550
Mailing Address - Street 1:91-1019 KAMAAHA AVE
Mailing Address - Street 2:1004
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2996
Mailing Address - Country:US
Mailing Address - Phone:603-380-4550
Mailing Address - Fax:603-658-2679
Practice Address - Street 1:91-1019 KAMAAHA AVE
Practice Address - Street 2:1004
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2996
Practice Address - Country:US
Practice Address - Phone:603-380-4500
Practice Address - Fax:603-658-2679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1454363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty