Provider Demographics
NPI:1548398597
Name:GLENN, TERRI L (NP)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:GLENN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 EAST M72
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49690
Mailing Address - Country:US
Mailing Address - Phone:231-938-2366
Mailing Address - Fax:231-938-5841
Practice Address - Street 1:3990 EAST M72
Practice Address - Street 2:
Practice Address - City:ACME
Practice Address - State:MI
Practice Address - Zip Code:49610-1739
Practice Address - Country:US
Practice Address - Phone:231-938-2366
Practice Address - Fax:231-938-5841
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704118887363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily