Provider Demographics
NPI:1720836943
Name:GREENAWAY, GLENFORD U
Entity type:Individual
Prefix:MR
First Name:GLENFORD
Middle Name:U
Last Name:GREENAWAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WASHINGTON AVE S STE 1210
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-2511
Mailing Address - Country:US
Mailing Address - Phone:866-492-5336
Mailing Address - Fax:
Practice Address - Street 1:100 WASHINGTON AVE S STE 1210
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55401-2511
Practice Address - Country:US
Practice Address - Phone:866-492-5336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program