Provider Demographics
NPI:1023332426
Name:MCPHERSON, GLENDA (CDN)
Entity type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 CRITTENDEN BLVD
Mailing Address - Street 2:BOX 617
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-8617
Mailing Address - Country:US
Mailing Address - Phone:585-275-2662
Mailing Address - Fax:585-256-1285
Practice Address - Street 1:250 CRITTENDEN BLVD
Practice Address - Street 2:BOX 617
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-8617
Practice Address - Country:US
Practice Address - Phone:585-275-2662
Practice Address - Fax:585-256-1285
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY568228133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic