Provider Demographics
NPI:1508924127
Name:LEVIN, GLENDA LEE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:LEE
Last Name:LEVIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 COLONIAL DR
Mailing Address - Street 2:PO BOX 196
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-2028
Mailing Address - Country:US
Mailing Address - Phone:803-541-6952
Mailing Address - Fax:
Practice Address - Street 1:811 REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812-1573
Practice Address - Country:US
Practice Address - Phone:803-541-4368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1566367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered