Provider Demographics
NPI:1184388910
Name:CURTIS, GLENN ALLEN (REGISTERED NURSE)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:ALLEN
Last Name:CURTIS
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:MR
Other - First Name:GLENN
Other - Middle Name:ALLEN
Other - Last Name:CURTIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16709 STANFORD PLACE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034
Mailing Address - Country:US
Mailing Address - Phone:314-838-8543
Mailing Address - Fax:
Practice Address - Street 1:16709 STANFORD PL DRIVE
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034
Practice Address - Country:US
Practice Address - Phone:314-740-1681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No282E00000XHospitalsLong Term Care Hospital
No347B00000XTransportation ServicesBus