Provider Demographics
NPI:1740473685
Name:STUMP, GLYNNA MARIE (RN)
Entity type:Individual
Prefix:MS
First Name:GLYNNA
Middle Name:MARIE
Last Name:STUMP
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 EAST NIZHONI BOULEVARD
Mailing Address - Street 2:P.O. BOX 1337
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-1337
Mailing Address - Country:US
Mailing Address - Phone:505-722-1260
Mailing Address - Fax:505-726-8740
Practice Address - Street 1:516 EAST NIZHONI BOULEVARD
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-1337
Practice Address - Country:US
Practice Address - Phone:505-722-1260
Practice Address - Fax:505-726-8740
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR45901163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care