Provider Demographics
NPI:1720448400
Name:GLIENKE, BRIGETTE
Entity Type:Individual
Prefix:
First Name:BRIGETTE
Middle Name:
Last Name:GLIENKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MN
Mailing Address - Zip Code:56081-1130
Mailing Address - Country:US
Mailing Address - Phone:507-399-4916
Mailing Address - Fax:
Practice Address - Street 1:717 1ST ST N
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MN
Practice Address - Zip Code:56081-1130
Practice Address - Country:US
Practice Address - Phone:507-399-4916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker