Provider Demographics
NPI:1003943754
Name:GLENN, LORI ANN (RN MS CNM)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:GLENN
Suffix:
Gender:F
Credentials:RN MS CNM
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Mailing Address - Street 1:5096 TWILIGHT DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-8960
Mailing Address - Country:US
Mailing Address - Phone:810-265-2623
Mailing Address - Fax:
Practice Address - Street 1:115 E PIERSON RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48505-3307
Practice Address - Country:US
Practice Address - Phone:810-600-2444
Practice Address - Fax:810-785-9675
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704165153367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife