Provider Demographics
NPI:1962814442
Name:GREENWOOD, MARY JANE (CNM, WHNP-BC, IBCLC)
Entity Type:Individual
Prefix:MS
First Name:MARY JANE
Middle Name:
Last Name:GREENWOOD
Suffix:
Gender:F
Credentials:CNM, WHNP-BC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WATERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-2069
Mailing Address - Country:US
Mailing Address - Phone:603-354-6640
Mailing Address - Fax:603-354-6645
Practice Address - Street 1:2 TRAP FALLS RD STE 510
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-7622
Practice Address - Country:US
Practice Address - Phone:203-944-0264
Practice Address - Fax:203-944-0838
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT168570163WL0100X
NH067583-21163WL0100X
NH067583-23363LW0102X, 367A00000X
CT471176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife