Provider Demographics
NPI:1720592124
Name:GLENN, RICHELLE LENAE (RN-MSN)
Entity Type:Individual
Prefix:MS
First Name:RICHELLE
Middle Name:LENAE
Last Name:GLENN
Suffix:
Gender:F
Credentials:RN-MSN
Other - Prefix:MS
Other - First Name:RICHELLE
Other - Middle Name:LENAE
Other - Last Name:HONCOOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:220 WEST KORTSEN ROAD
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85722
Mailing Address - Country:US
Mailing Address - Phone:520-836-7787
Mailing Address - Fax:
Practice Address - Street 1:220 W KORTSEN RD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5910
Practice Address - Country:US
Practice Address - Phone:520-836-7787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN158765163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse