Provider Demographics
NPI:1851545826
Name:FORAN, GLENN ARTHUR (RN)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:ARTHUR
Last Name:FORAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-5033
Mailing Address - Country:US
Mailing Address - Phone:562-607-1614
Mailing Address - Fax:
Practice Address - Street 1:915 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-5033
Practice Address - Country:US
Practice Address - Phone:562-607-1614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA401099163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse