Provider Demographics
NPI:1811504590
Name:GREENWOOD, ANTHONY ROBERT
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:ROBERT
Last Name:GREENWOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-1525
Mailing Address - Country:US
Mailing Address - Phone:563-822-1435
Mailing Address - Fax:563-822-1436
Practice Address - Street 1:712 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:IA
Practice Address - Zip Code:52057-1525
Practice Address - Country:US
Practice Address - Phone:563-822-1435
Practice Address - Fax:563-822-1436
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9039506-3102163W00000X
IAD161940367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty