Provider Demographics
NPI:1619612272
Name:OXENDER, GLYNDA (FNP-C)
Entity Type:Individual
Prefix:
First Name:GLYNDA
Middle Name:
Last Name:OXENDER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:GLYNDA
Other - Middle Name:M
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 W MICHIGAN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-5378
Mailing Address - Country:US
Mailing Address - Phone:734-221-5440
Mailing Address - Fax:734-221-5492
Practice Address - Street 1:301 W MICHIGAN AVE STE 100
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-5378
Practice Address - Country:US
Practice Address - Phone:734-221-5440
Practice Address - Fax:734-221-5492
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704245331363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner