Provider Demographics
NPI:1295183101
Name:GREENWOOD, SUE (RN)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:GREENWOOD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 E 32 RD
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-9178
Mailing Address - Country:US
Mailing Address - Phone:231-779-3782
Mailing Address - Fax:
Practice Address - Street 1:209 E CHIPPEWA ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-1609
Practice Address - Country:US
Practice Address - Phone:989-772-1261
Practice Address - Fax:989-772-1300
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704171003163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse