Provider Demographics
NPI:1790548691
Name:MANSELL, GLENN PAUL JR (RN)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:PAUL
Last Name:MANSELL
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8819 W VICTORIA AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7193
Mailing Address - Country:US
Mailing Address - Phone:509-783-1851
Mailing Address - Fax:866-425-2390
Practice Address - Street 1:8819 W VICTORIA AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7193
Practice Address - Country:US
Practice Address - Phone:509-378-8675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WARN00138524163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health