Provider Demographics
NPI:1417106824
Name:GLENNAN, CHRISTEN (RN, MS, CPNP)
Entity Type:Individual
Prefix:
First Name:CHRISTEN
Middle Name:
Last Name:GLENNAN
Suffix:
Gender:F
Credentials:RN, MS, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 N MAIN ST
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-1216
Mailing Address - Country:US
Mailing Address - Phone:928-458-5470
Mailing Address - Fax:928-458-5979
Practice Address - Street 1:3001 N MAIN ST
Practice Address - Street 2:SUITE 1C
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-1216
Practice Address - Country:US
Practice Address - Phone:928-458-5470
Practice Address - Fax:928-458-5979
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3128363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ374956Medicaid