Provider Demographics
NPI:1003111824
Name:ELOGE, GLENDA LAINE (NP)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:LAINE
Last Name:ELOGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GLENDA
Other - Middle Name:LAINE
Other - Last Name:SASSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5353 REYNOLDS ST
Mailing Address - Street 2:STE 300
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6015
Mailing Address - Country:US
Mailing Address - Phone:912-355-6005
Mailing Address - Fax:912-355-5643
Practice Address - Street 1:5353 REYNOLDS ST
Practice Address - Street 2:STE 300
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6015
Practice Address - Country:US
Practice Address - Phone:912-355-6005
Practice Address - Fax:912-355-5643
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN111985 NP363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology