Provider Demographics
NPI:1730315169
Name:GLENN, TAMI S (CRNA)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:S
Last Name:GLENN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:10 WOODLAND RD.
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-9554
Practice Address - Country:US
Practice Address - Phone:707-963-3611
Practice Address - Fax:707-967-5622
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2016-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA567793163W00000X
OR201340251RN163W00000X
WARN00137861163W00000X
WAAP60098103367500000X
CA4118367500000X
OR201360008CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse