Provider Demographics
NPI:1760577472
Name:MILLER, GLENDA JO (RN)
Entity Type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:JO
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:GLENDA
Other - Middle Name:JO
Other - Last Name:LE SEUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6705 S SANTA FE DR
Mailing Address - Street 2:#47
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-2937
Mailing Address - Country:US
Mailing Address - Phone:720-283-3052
Mailing Address - Fax:720-283-3052
Practice Address - Street 1:260 S KIPLING ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-1086
Practice Address - Country:US
Practice Address - Phone:303-239-7024
Practice Address - Fax:303-239-7088
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36601163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71153268Medicaid