Provider Demographics
NPI:1972068054
Name:GLENN, DIANE CAROL (APRN, FNP-C, SANE)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:CAROL
Last Name:GLENN
Suffix:
Gender:F
Credentials:APRN, FNP-C, SANE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 WEAVER RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-2998
Mailing Address - Country:US
Mailing Address - Phone:859-282-9390
Mailing Address - Fax:
Practice Address - Street 1:375 WEAVER RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-2998
Practice Address - Country:US
Practice Address - Phone:859-111-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013011363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily