Provider Demographics
NPI:1043642630
Name:LANDRUM, GLENDA J (NA-C)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:J
Last Name:LANDRUM
Suffix:
Gender:F
Credentials:NA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 196TH ST SW STE B-404
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6773
Mailing Address - Country:US
Mailing Address - Phone:206-765-8664
Mailing Address - Fax:
Practice Address - Street 1:5622 168TH ST SW APT 1
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-8300
Practice Address - Country:US
Practice Address - Phone:206-353-4091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC 60262062376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide