Provider Demographics
NPI:1346550753
Name:GLENN, ROMIKA TANELLE (RN, MSN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:ROMIKA
Middle Name:TANELLE
Last Name:GLENN
Suffix:
Gender:F
Credentials:RN, MSN, NP-C
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8864 GROVER ST
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-4124
Mailing Address - Country:US
Mailing Address - Phone:734-331-2494
Mailing Address - Fax:
Practice Address - Street 1:2025 FORT ST
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-3841
Practice Address - Country:US
Practice Address - Phone:734-320-0525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704218454163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse