Provider Demographics
NPI:1174557714
Name:GLENNON, MARGARET ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ELIZABETH
Last Name:GLENNON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:GLENNON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1500 CURVE CREST BLVD W
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6040
Mailing Address - Country:US
Mailing Address - Phone:651-439-1234
Mailing Address - Fax:651-275-3325
Practice Address - Street 1:1500 CURVE CREST BLVD W
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6040
Practice Address - Country:US
Practice Address - Phone:651-439-1234
Practice Address - Fax:651-275-3325
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2369-023363A00000X
MN9387363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN150076OtherUCARE
WI561250047OtherMEDICARE
MN2251248OtherARAZ
MN1031503OtherPREFERRED ONE
MT4306653Medicaid
MNHP48571OtherHEALTHPARTNERS
MN01-22013OtherMEDICA CHOICE
MN01-14853OtherMEDICA PRIMARY
MN711T0GLOtherBCBS
MN55411070Medicaid
MN150076OtherUCARE