Provider Demographics
NPI:1942014063
Name:GREENWALT, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:GREENWALT
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 1:225 N WEBB RD STE 3
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4041
Mailing Address - Country:US
Mailing Address - Phone:308-850-5981
Mailing Address - Fax:
Practice Address - Street 1:225 N WEBB RD STE 3
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4041
Practice Address - Country:US
Practice Address - Phone:308-850-5981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist