Provider Demographics
NPI:1891194163
Name:BELL, GLENN R (LPN)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:R
Last Name:BELL
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 2ND ST E
Mailing Address - Street 2:SUITE 4-G
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1029
Mailing Address - Country:US
Mailing Address - Phone:941-747-8404
Mailing Address - Fax:941-714-7569
Practice Address - Street 1:250 2ND ST E
Practice Address - Street 2:SUITE 4-G
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1029
Practice Address - Country:US
Practice Address - Phone:941-747-8404
Practice Address - Fax:941-714-7569
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-22
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN 1285321164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse