Provider Demographics
NPI:1023885043
Name:GLENN, THOMAS WILLIAM (RN)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:WILLIAM
Last Name:GLENN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 N I ST APT 1
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-2080
Mailing Address - Country:US
Mailing Address - Phone:253-640-5272
Mailing Address - Fax:
Practice Address - Street 1:723 N I ST APT 1
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-2080
Practice Address - Country:US
Practice Address - Phone:253-640-5272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00070740163WH1000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice
No163W00000XNursing Service ProvidersRegistered Nurse