Provider Demographics
NPI:1881835056
Name:GLENN, TRACEY ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:ANN
Last Name:GLENN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 HAINS AVENUE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354
Mailing Address - Country:US
Mailing Address - Phone:509-366-6107
Mailing Address - Fax:509-946-7162
Practice Address - Street 1:1305 HAINS AVENUE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354
Practice Address - Country:US
Practice Address - Phone:509-366-6107
Practice Address - Fax:509-946-7162
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2019-03-05
Deactivation Date:2019-02-08
Deactivation Code:
Reactivation Date:2019-03-05
Provider Licenses
StateLicense IDTaxonomies
WARN00152763163W00000X
WAAP30008011363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse