Provider Demographics
NPI:1679678130
Name:MUSICK, GLENDA JEAN
Entity Type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:JEAN
Last Name:MUSICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 SUNSET VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-3140
Mailing Address - Country:US
Mailing Address - Phone:330-630-2624
Mailing Address - Fax:
Practice Address - Street 1:724 SUNSET VIEW BLVD
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-3140
Practice Address - Country:US
Practice Address - Phone:330-630-2624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2157857Medicaid