Provider Demographics
NPI:1477079820
Name:HUNTER, GLENYS NDAKA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:GLENYS
Middle Name:NDAKA
Last Name:HUNTER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6703 CIELITO WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1710
Mailing Address - Country:US
Mailing Address - Phone:408-499-3491
Mailing Address - Fax:
Practice Address - Street 1:2110 MCKEE RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1427
Practice Address - Country:US
Practice Address - Phone:408-258-5083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006697363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care