Provider Demographics
NPI:1881195048
Name:MOTT, GLENN EDWARD (APRN)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:EDWARD
Last Name:MOTT
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:MR
Other - First Name:GLENN
Other - Middle Name:EDWARD
Other - Last Name:MOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:250 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-7559
Mailing Address - Country:US
Mailing Address - Phone:603-225-2711
Mailing Address - Fax:603-224-6527
Practice Address - Street 1:250 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2598
Practice Address - Country:US
Practice Address - Phone:603-225-2711
Practice Address - Fax:603-224-6527
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH048276-23207Q00000X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily