Provider Demographics
NPI:1013088483
Name:LAIRD, GLENN BRIAN (LVN)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:BRIAN
Last Name:LAIRD
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:GLENN
Other - Middle Name:BRIAN
Other - Last Name:LAIRD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LVN
Mailing Address - Street 1:4221 PERTH DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79922-1226
Mailing Address - Country:US
Mailing Address - Phone:915-833-4778
Mailing Address - Fax:
Practice Address - Street 1:5005 N PIEDRAS ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920-5001
Practice Address - Country:US
Practice Address - Phone:915-598-0474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX149313164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse