Provider Demographics
NPI:1689980799
Name:MARSH, GLENDA JOYCE (NP)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:JOYCE
Last Name:MARSH
Suffix:
Gender:F
Credentials:NP
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 3008
Mailing Address - Street 2:
Mailing Address - City:GLEN ROSE
Mailing Address - State:TX
Mailing Address - Zip Code:76043-3008
Mailing Address - Country:US
Mailing Address - Phone:979-236-0728
Mailing Address - Fax:
Practice Address - Street 1:1200 ENCLAVE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-1733
Practice Address - Country:US
Practice Address - Phone:979-236-0728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX222854363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics