Provider Demographics
NPI:1578622817
Name:GLENN, BYRON CORRIE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:BYRON
Middle Name:CORRIE
Last Name:GLENN
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:203 N WASHINGTON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0233
Mailing Address - Country:US
Mailing Address - Phone:509-444-8888
Mailing Address - Fax:509-444-7806
Practice Address - Street 1:401 S. MAIN AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006
Practice Address - Country:US
Practice Address - Phone:509-434-0292
Practice Address - Fax:509-434-0285
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2011-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAAP 60001347363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily