Provider Demographics
NPI:1275845935
Name:TOWNSEND, GLENN PHILIP (NP-C)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:PHILIP
Last Name:TOWNSEND
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 N 95TH AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-4313
Mailing Address - Country:US
Mailing Address - Phone:623-234-9811
Mailing Address - Fax:623-234-9815
Practice Address - Street 1:1840 N 95TH AVE STE 160
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-4313
Practice Address - Country:US
Practice Address - Phone:623-234-9811
Practice Address - Fax:623-234-9815
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3724363LA2200X
AZAP8266363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health