Individual
JACQUELINE M GREENWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4417 HIGHWAY 223 S, VIOLA, AR 72583-9559
(870) 458-2862
Mailing address
4417 HIGHWAY 223 S, VIOLA, AR 72583-9559
(870) 458-2862
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
175831783
MEDICAID PROVIDER IDENTIFICATION NUMBER
AR
Enumeration date
01/07/2010
Last updated
01/07/2010
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