Provider Demographics
NPI:1740276559
Name:GREENWOOD-KORSON, ROSALIE (NP)
Entity type:Individual
Prefix:
First Name:ROSALIE
Middle Name:
Last Name:GREENWOOD-KORSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ROSALIE
Other - Middle Name:
Other - Last Name:GREENWOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:43800 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1136
Mailing Address - Country:US
Mailing Address - Phone:800-848-0202
Mailing Address - Fax:586-226-6949
Practice Address - Street 1:19229 MACK AVE
Practice Address - Street 2:#28
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-2858
Practice Address - Country:US
Practice Address - Phone:313-647-3200
Practice Address - Fax:313-343-7937
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704084913163WP0218X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0218XNursing Service ProvidersRegistered NursePediatric Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4194403Medicaid
P10587Medicare UPIN
ON11180003Medicare ID - Type Unspecified