Provider Demographics
NPI:1730556879
Name:GREENWOOD, ALICE
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:GREENWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800S SHIRLINGTON RD 500
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-3618
Mailing Address - Country:US
Mailing Address - Phone:703-717-4245
Mailing Address - Fax:
Practice Address - Street 1:2800 S SHIRLINGTON RD
Practice Address - Street 2:SUITE 500
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-3601
Practice Address - Country:US
Practice Address - Phone:703-717-4245
Practice Address - Fax:703-717-4248
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172866363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily