Provider Demographics
NPI:1124142591
Name:GREENWOOD, LINDA ANNE (LIC AC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:ANNE
Last Name:GREENWOOD
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 STATE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5576
Mailing Address - Country:US
Mailing Address - Phone:720-376-1872
Mailing Address - Fax:
Practice Address - Street 1:16 PENN PLZ STE 22
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3620
Practice Address - Country:US
Practice Address - Phone:207-947-8077
Practice Address - Fax:207-947-3721
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist