Provider Demographics
NPI:1871188227
Name:FOX, GLENNA MAE (BSN,RN)
Entity Type:Individual
Prefix:
First Name:GLENNA MAE
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:BSN,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PHOENIX ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-2023
Mailing Address - Country:US
Mailing Address - Phone:585-797-4026
Mailing Address - Fax:
Practice Address - Street 1:20 PHOENIX ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-2023
Practice Address - Country:US
Practice Address - Phone:585-797-4026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY587453163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health