Basic Information
| Provider Information | |||||||||
| NPI: | 1780649228 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRYNWALD | ||||||||
| FirstName: | ANA | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 950202 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402950202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022725100 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 E CHESTNUT ST STE 303 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026295552 | ||||||||
| FaxNumber: | 5026293132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 02/21/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 60951 | WV | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 5401P | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 3005401 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 3810001426 | 05 | WV | MEDICAID | 000000662212 | 01 | KY | ANTHEM - NIS | OTHER | 5267182 | 01 | KY | CIGNA - NIS | OTHER | P00471692 | 01 | RAIL ROAD MEDICARE | OTHER | 201048040 | 05 | IN | MEDICAID | 000052153K | 01 | KY | HUMANA - NIS | OTHER | 114969 | 01 | KY | SIHO - NIS | OTHER | 2519788 | 05 | OH | MEDICAID | 000000534400 | 01 | KY | BCBS | OTHER | 50035741 | 01 | KY | PASSPORT - NIS | OTHER | 78012929 | 05 | KY | MEDICAID |