Provider Demographics
NPI:1548298409
Name:GREENWALD, TRINA L (MSN, FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:TRINA
Middle Name:L
Last Name:GREENWALD
Suffix:
Gender:F
Credentials:MSN, FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 N BRADNER AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2449
Mailing Address - Country:US
Mailing Address - Phone:765-664-8000
Mailing Address - Fax:877-731-2066
Practice Address - Street 1:515 N BRADNER AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2449
Practice Address - Country:US
Practice Address - Phone:765-664-8000
Practice Address - Fax:877-731-2066
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002182A363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN9127305OtherAETNA
IN000000799231OtherANTHEM
IN200844580Medicaid
INM400025119Medicare PIN
IN200844580Medicaid
ININ1279001Medicare PIN