Provider Demographics
NPI:1275671141
Name:MCNAMARA, GLENDA LYNN (PA)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:LYNN
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3495 S CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-1455
Mailing Address - Country:US
Mailing Address - Phone:810-424-2007
Mailing Address - Fax:810-743-1099
Practice Address - Street 1:944 BALDWIN RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3089
Practice Address - Country:US
Practice Address - Phone:810-245-5562
Practice Address - Fax:810-245-7838
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601004310363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ31378Medicare UPIN