Provider Demographics
NPI:1396930756
Name:GLENN, JUDY JEAN (CNM)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:JEAN
Last Name:GLENN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7721 CALINA WAY
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-8104
Mailing Address - Country:US
Mailing Address - Phone:760-519-2615
Mailing Address - Fax:
Practice Address - Street 1:7721 CALINA WAY
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-8104
Practice Address - Country:US
Practice Address - Phone:760-519-2615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 229194 NP 10606363L00000X
CANMW 465367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner