Provider Demographics
NPI:1497933980
Name:SMITH, GLENDA L (CRNP)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:GLENDA
Other - Middle Name:L
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:203 WEST LEE ST
Mailing Address - Street 2:
Mailing Address - City:TUSKEGEE
Mailing Address - State:AL
Mailing Address - Zip Code:36083
Mailing Address - Country:US
Mailing Address - Phone:334-727-7050
Mailing Address - Fax:334-727-6284
Practice Address - Street 1:203 W LEE ST
Practice Address - Street 2:
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083-1719
Practice Address - Country:US
Practice Address - Phone:334-727-7050
Practice Address - Fax:334-727-6284
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1073428363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics