Provider Demographics
NPI:1164668950
Name:MORRISON, GLENDY LEA (LMP)
Entity Type:Individual
Prefix:MRS
First Name:GLENDY
Middle Name:LEA
Last Name:MORRISON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6109 ALLA MADISON DR
Mailing Address - Street 2:
Mailing Address - City:TULALIP
Mailing Address - State:WA
Mailing Address - Zip Code:98271-6548
Mailing Address - Country:US
Mailing Address - Phone:425-268-8184
Mailing Address - Fax:
Practice Address - Street 1:6109 ALLA MADISON DR
Practice Address - Street 2:
Practice Address - City:TULALIP
Practice Address - State:WA
Practice Address - Zip Code:98271-6548
Practice Address - Country:US
Practice Address - Phone:425-268-8184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-28
Last Update Date:2008-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60055124172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker