Provider Demographics
NPI:1598186967
Name:PRICE, GLENNA LE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:GLENNA
Middle Name:LE
Last Name:PRICE
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 1:469 SOUTHWOODS DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-7229
Mailing Address - Country:US
Mailing Address - Phone:845-707-8425
Mailing Address - Fax:845-707-8954
Practice Address - Street 1:469 SOUTHWOODS DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-7229
Practice Address - Country:US
Practice Address - Phone:845-707-8425
Practice Address - Fax:845-707-8954
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097268-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse