Provider Demographics
NPI:1508192204
Name:SLOMER, GLENNA M
Entity Type:Individual
Prefix:
First Name:GLENNA
Middle Name:M
Last Name:SLOMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 APPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5293
Mailing Address - Country:US
Mailing Address - Phone:513-479-2540
Mailing Address - Fax:
Practice Address - Street 1:43 APPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5293
Practice Address - Country:US
Practice Address - Phone:513-479-2540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN115328 MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse