Provider Demographics
NPI:1043387830
Name:LIRMAN, GLENN RONALD (ARNP)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:RONALD
Last Name:LIRMAN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4330 WALLINGFORD AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7542
Mailing Address - Country:US
Mailing Address - Phone:206-205-2415
Mailing Address - Fax:206-205-2439
Practice Address - Street 1:620 W JAMES ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4487
Practice Address - Country:US
Practice Address - Phone:206-205-2400
Practice Address - Fax:206-205-2439
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003222363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAS81183Medicare UPIN