Provider Demographics
NPI:1639935950
Name:MCMILLAN, GLENNA (LM, CPM)
Entity Type:Individual
Prefix:
First Name:GLENNA
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3074 W MENDES DR
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93656-9772
Mailing Address - Country:US
Mailing Address - Phone:559-790-1440
Mailing Address - Fax:
Practice Address - Street 1:3074 W MENDES DR
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:CA
Practice Address - Zip Code:93656-9772
Practice Address - Country:US
Practice Address - Phone:559-790-1440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM734176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife