Provider Demographics
NPI:1073112884
Name:GLENN, CYNTHIA MCCARTY
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MCCARTY
Last Name:GLENN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 272
Mailing Address - Street 2:
Mailing Address - City:VAN
Mailing Address - State:WV
Mailing Address - Zip Code:25206-0272
Mailing Address - Country:US
Mailing Address - Phone:304-245-8308
Mailing Address - Fax:
Practice Address - Street 1:79 JOE GLENN DRIVE
Practice Address - Street 2:
Practice Address - City:VAN
Practice Address - State:WV
Practice Address - Zip Code:25206
Practice Address - Country:US
Practice Address - Phone:304-245-8308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant