Provider Demographics
NPI:1518323401
Name:SEPULVEDA, GLENDA EILEEN (LPN)
Entity Type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:EILEEN
Last Name:SEPULVEDA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 COUNTRY CLUB LN
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2557
Mailing Address - Country:US
Mailing Address - Phone:845-309-0647
Mailing Address - Fax:
Practice Address - Street 1:555 CHESTNUT RIDGE RD
Practice Address - Street 2:
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677-8417
Practice Address - Country:US
Practice Address - Phone:201-391-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270041-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse