Provider Demographics
NPI:1477596450
Name:DENHERDER, GLENDA F (APRN)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:F
Last Name:DENHERDER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 4TH ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1750
Mailing Address - Country:US
Mailing Address - Phone:712-234-0220
Mailing Address - Fax:712-234-0225
Practice Address - Street 1:600 4TH ST
Practice Address - Street 2:SUITE 501
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1750
Practice Address - Country:US
Practice Address - Phone:712-234-0220
Practice Address - Fax:712-234-0225
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA061517363LP0808X
NE110339363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAT-061517 CNS ADULTOtherARNP LICENSE
IA1477596450OtherWELLMARK BCBS
IA0339681OtherBOARD CERTIFICATION ANCC
NE10025162300Medicaid