Provider Demographics
NPI:1740394808
Name:CAIN, GLENDA M (RN,FNP)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:M
Last Name:CAIN
Suffix:
Gender:F
Credentials:RN,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 FORESIGHT CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1139
Mailing Address - Country:US
Mailing Address - Phone:970-242-2660
Mailing Address - Fax:970-242-0080
Practice Address - Street 1:2570 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1438
Practice Address - Country:US
Practice Address - Phone:970-298-6601
Practice Address - Fax:970-298-6641
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO106236363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO35331259Medicaid
COCO300214BASINCLINICMedicare PIN
CO35331259Medicaid
CO800679Medicare ID - Type Unspecified