Provider Demographics
NPI:1801000724
Name:GREENWELL, DANA M (DI)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:M
Last Name:GREENWELL
Suffix:
Gender:
Credentials:DI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 OXFORD PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3744
Mailing Address - Country:US
Mailing Address - Phone:502-836-9751
Mailing Address - Fax:
Practice Address - Street 1:521 OXFORD PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3744
Practice Address - Country:US
Practice Address - Phone:502-836-9751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1463OtherCBIS PROVIDER NUMBER