Provider Demographics
NPI:1922064195
Name:ROBISON, GLENDA D (RNC, WHNP)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:D
Last Name:ROBISON
Suffix:
Gender:F
Credentials:RNC, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S MOUNT AUBURN RD
Mailing Address - Street 2:SUITE 318
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-4910
Mailing Address - Country:US
Mailing Address - Phone:573-339-1166
Mailing Address - Fax:573-339-7166
Practice Address - Street 1:150 S MOUNT AUBURN RD
Practice Address - Street 2:SUITE 318
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4910
Practice Address - Country:US
Practice Address - Phone:573-339-1166
Practice Address - Fax:573-339-7166
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO121047363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO80785Medicare ID - Type UnspecifiedMEDICARE PROVIDER
MOP14450Medicare UPIN