Provider Demographics
NPI:1518936863
Name:GLYN, JANENE R (MD)
Entity Type:Individual
Prefix:DR
First Name:JANENE
Middle Name:R
Last Name:GLYN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 NININGER RD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-1086
Mailing Address - Country:US
Mailing Address - Phone:651-480-4200
Mailing Address - Fax:
Practice Address - Street 1:1285 NININGER RD
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-1086
Practice Address - Country:US
Practice Address - Phone:651-480-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY8620A208000000X
MN42887208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN127968OtherUCARE MINNESOTA
MN34005200OtherMEDICAID WI
MN34005200OtherGROUP HEALTH EAU CLAIRE
MNHP31065OtherHEALTH PARTNERS
MN12-00895OtherMEDICA
MN66-07835OtherMEDICA URGENT CARE
MN190150800Medicaid
MN27F14GLOtherBLUE CROSS
MN370020464OtherRAILROAD MEDICARE
MNNA9141025070OtherPREFERRED ONE
MN1072689OtherAMERICA'S PPO
MNC16168Medicare UPIN
MNHP31065OtherHEALTH PARTNERS