Provider Demographics
NPI:1255816039
Name:MARCUS, GLENNA BELIN (LM)
Entity type:Individual
Prefix:
First Name:GLENNA
Middle Name:BELIN
Last Name:MARCUS
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 84
Mailing Address - Street 2:
Mailing Address - City:OHKAY OWINGEH
Mailing Address - State:NM
Mailing Address - Zip Code:87566-0084
Mailing Address - Country:US
Mailing Address - Phone:505-221-3431
Mailing Address - Fax:
Practice Address - Street 1:905B CALLE ARMADA
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-0000
Practice Address - Country:US
Practice Address - Phone:505-753-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM18183R176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife