Provider Demographics
NPI:1629506894
Name:GLENN, JESSICA M (LPN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
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 1:11651 NORBOURNE DR APT 213
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-6053
Mailing Address - Country:US
Mailing Address - Phone:513-704-2096
Mailing Address - Fax:
Practice Address - Street 1:11651 NORBOURNE DR APT 213
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-6053
Practice Address - Country:US
Practice Address - Phone:513-704-2096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH165100164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse