Provider Demographics
NPI:1033084710
Name:GLENN, JAANNA DESIREE CARMILLA
Entity type:Individual
Prefix:
First Name:JAANNA
Middle Name:DESIREE CARMILLA
Last Name:GLENN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8954 SAINT MARYS ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-2048
Mailing Address - Country:US
Mailing Address - Phone:313-810-4291
Mailing Address - Fax:
Practice Address - Street 1:8954 SAINT MARYS ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-2048
Practice Address - Country:US
Practice Address - Phone:313-810-4291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-10
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)