Provider Demographics
NPI:1407471071
Name:DAYANAN, GLENN ABAN (RN)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:ABAN
Last Name:DAYANAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8920 55TH AVE APT 7D
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4514
Mailing Address - Country:US
Mailing Address - Phone:646-918-9018
Mailing Address - Fax:
Practice Address - Street 1:8920 55TH AVE APT 7D
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4514
Practice Address - Country:US
Practice Address - Phone:646-918-9018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY744259163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse