Provider Demographics
NPI:1861819625
Name:VANHAITSMA, GLENDA HENDRICA (RN)
Entity Type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:HENDRICA
Last Name:VANHAITSMA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 COLLEGE ST NE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-5390
Mailing Address - Country:US
Mailing Address - Phone:360-412-4663
Mailing Address - Fax:
Practice Address - Street 1:305 COLLEGE ST NE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-5390
Practice Address - Country:US
Practice Address - Phone:360-412-4663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00123944163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse