Provider Demographics
NPI:1013652262
Name:STEPHENS, GLENNDA JEAN (RN)
Entity Type:Individual
Prefix:
First Name:GLENNDA
Middle Name:JEAN
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-7880
Mailing Address - Country:US
Mailing Address - Phone:989-274-2798
Mailing Address - Fax:631-380-5761
Practice Address - Street 1:916 FREMONT ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-7880
Practice Address - Country:US
Practice Address - Phone:989-274-2798
Practice Address - Fax:631-380-5761
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704111874163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management