Provider Demographics
NPI:1013562743
Name:CHEESEMAN, GLYNN WAYNE
Entity Type:Individual
Prefix:MR
First Name:GLYNN
Middle Name:WAYNE
Last Name:CHEESEMAN
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 1:1001 N FIREWOOD PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85748-1966
Mailing Address - Country:US
Mailing Address - Phone:520-403-3934
Mailing Address - Fax:520-722-9372
Practice Address - Street 1:1001 N FIREWOOD PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85748-1966
Practice Address - Country:US
Practice Address - Phone:520-403-3934
Practice Address - Fax:520-722-9372
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider