Provider Demographics
NPI:1982648481
Name:GLENN, CHRISTINA MARIE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:GLENN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 S DOWNING ST
Mailing Address - Street 2:STE 380
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5847
Mailing Address - Country:US
Mailing Address - Phone:303-778-5797
Mailing Address - Fax:303-778-5205
Practice Address - Street 1:12605 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2545
Practice Address - Country:US
Practice Address - Phone:720-848-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00362363A00000X, 363AM0700X
CO0004023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO78209749Medicaid
CO78209749Medicaid