Provider Demographics
NPI:1265868913
Name:DEUTSCH, GLENDA CLARK (DIPLOMA)
Entity type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:CLARK
Last Name:DEUTSCH
Suffix:
Gender:F
Credentials:DIPLOMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2283 HEMLOCK FARMS
Mailing Address - Street 2:
Mailing Address - City:LORDS VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18428-9155
Mailing Address - Country:US
Mailing Address - Phone:570-290-1858
Mailing Address - Fax:570-775-6423
Practice Address - Street 1:104 RODEO LANE
Practice Address - Street 2:
Practice Address - City:LORDS VALLEY
Practice Address - State:PA
Practice Address - Zip Code:18428-9155
Practice Address - Country:US
Practice Address - Phone:570-290-1858
Practice Address - Fax:570-775-6423
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
173C00000X
PARN541614163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
No163W00000XNursing Service ProvidersRegistered Nurse