Provider Demographics
NPI:1376715177
Name:CROSS, GLENNA E (LPN)
Entity Type:Individual
Prefix:MS
First Name:GLENNA
Middle Name:E
Last Name:CROSS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1583 CORONET DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-6201
Mailing Address - Country:US
Mailing Address - Phone:614-554-1156
Mailing Address - Fax:
Practice Address - Street 1:1583 CORONET DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-6201
Practice Address - Country:US
Practice Address - Phone:614-554-1156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN053864164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2671541Medicaid