Provider Demographics
NPI:1477253680
Name:GUTHRIE, GLENNA (CRNP-PMH)
Entity Type:Individual
Prefix:MRS
First Name:GLENNA
Middle Name:
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:MISS
Other - First Name:GLENNA
Other - Middle Name:
Other - Last Name:ROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:223 DEERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21550-4840
Mailing Address - Country:US
Mailing Address - Phone:240-321-6601
Mailing Address - Fax:
Practice Address - Street 1:223 DEERFIELD DR
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:MD
Practice Address - Zip Code:21550-4840
Practice Address - Country:US
Practice Address - Phone:240-321-6601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR183021363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health