Provider Demographics
NPI:1649464538
Name:EVERETT, GLENNA JEAN (CERTIFIED STATE NURS)
Entity type:Individual
Prefix:MRS
First Name:GLENNA
Middle Name:JEAN
Last Name:EVERETT
Suffix:
Gender:F
Credentials:CERTIFIED STATE NURS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 BOGGS RD
Mailing Address - Street 2:CARING HEARTS HOME HEALTH
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701
Mailing Address - Country:US
Mailing Address - Phone:740-454-1059
Mailing Address - Fax:
Practice Address - Street 1:3930 BOGGS RD
Practice Address - Street 2:CARING HEARTS HOME HEALTH
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701
Practice Address - Country:US
Practice Address - Phone:740-454-1059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400153470802376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide