Provider Demographics
NPI:1962450015
Name:HAUSER-HENDERSON, GLYNIS CONCHITA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:GLYNIS
Middle Name:CONCHITA
Last Name:HAUSER-HENDERSON
Suffix:
Gender:F
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:LAPOINTE HEALTH CLINIC
Mailing Address - Street 2:BLDG 5979 DESERT STORM AVE
Mailing Address - City:FT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-5349
Mailing Address - Country:US
Mailing Address - Phone:270-956-0301
Mailing Address - Fax:270-956-0091
Practice Address - Street 1:LAPOINTE HEALTH CLINIC
Practice Address - Street 2:BLDG 5979 DESERT STORM AVE
Practice Address - City:FT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5349
Practice Address - Country:US
Practice Address - Phone:270-956-0301
Practice Address - Fax:270-956-0091
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN65817164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse