Provider Demographics
NPI:1689181521
Name:MILES, GLENDA (RN)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:GLADYS
Other - Middle Name:W
Other - Last Name:MWAMBIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7316 CEDAR LAKE ROAD
Mailing Address - Street 2:APT 8
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426
Mailing Address - Country:US
Mailing Address - Phone:612-442-3351
Mailing Address - Fax:
Practice Address - Street 1:7316 CEDAR LAKE ROAD
Practice Address - Street 2:APT 8
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426
Practice Address - Country:US
Practice Address - Phone:612-442-3351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-31
Last Update Date:2017-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR226288-8163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health