Provider Demographics
NPI:1508147513
Name:GREENWOOD, NICOLE KB (BA)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:KB
Last Name:GREENWOOD
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 SOUTHCENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2547
Mailing Address - Country:US
Mailing Address - Phone:206-901-2010
Mailing Address - Fax:206-901-2010
Practice Address - Street 1:6400 SOUTHCENTER BLVD
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2547
Practice Address - Country:US
Practice Address - Phone:206-901-2010
Practice Address - Fax:206-901-2010
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60173166101Y00000X
WANA00196242374700000X
WACU61573328101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No374700000XNursing Service Related ProvidersTechnician