Provider Demographics
NPI:1073847273
Name:ROSENDALE, GLENN M
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:M
Last Name:ROSENDALE
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 1:7900 BELL AVE SE
Mailing Address - Street 2:APT 15
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-4123
Mailing Address - Country:US
Mailing Address - Phone:505-254-0320
Mailing Address - Fax:505-254-8119
Practice Address - Street 1:7900 BELL AVE SE
Practice Address - Street 2:APT 15
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-4123
Practice Address - Country:US
Practice Address - Phone:505-254-0320
Practice Address - Fax:505-254-8119
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator