Provider Demographics
NPI:1700065620
Name:GLIMPSE, JEANETTE MARIE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:MARIE
Last Name:GLIMPSE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-3743
Mailing Address - Country:US
Mailing Address - Phone:316-284-0827
Mailing Address - Fax:
Practice Address - Street 1:115 S PINE ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-3743
Practice Address - Country:US
Practice Address - Phone:316-284-0827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-27
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-00388314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility