Provider Demographics
NPI:1578748091
Name:GLENN, AMMIE JO (LPN)
Entity Type:Individual
Prefix:MS
First Name:AMMIE
Middle Name:JO
Last Name:GLENN
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 1:1272 SHERIDAN DR APT G
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1942
Mailing Address - Country:US
Mailing Address - Phone:740-974-0752
Mailing Address - Fax:
Practice Address - Street 1:1272 SHERIDAN DR APT G
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1942
Practice Address - Country:US
Practice Address - Phone:740-974-0752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN107618164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse