Basic Information
| Provider Information | |||||||||
| NPI: | 1194348151 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREENSWEIG | ||||||||
| FirstName: | MELINDA | ||||||||
| MiddleName: | PEARL | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1130 WOODLAWN AVE | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462031125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6504409390 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16549 AURORA AVE N | ||||||||
| Address2: | |||||||||
| City: | SHORELINE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981335308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065332600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2020 | ||||||||
| LastUpdateDate: | 09/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | 28219007A | IN | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 363LF0000X | AP61081195 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.