Provider Demographics
NPI:1669503462
Name:POPE, GLENDA TESTON (CNP)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:TESTON
Last Name:POPE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 164
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87499-0164
Mailing Address - Country:US
Mailing Address - Phone:505-324-1100
Mailing Address - Fax:
Practice Address - Street 1:304 N LOCKE AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5855
Practice Address - Country:US
Practice Address - Phone:505-324-1100
Practice Address - Fax:505-324-1117
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR27867363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP33386Medicare UPIN