Provider Demographics
NPI:1740675172
Name:WHITE, GLENDA DENISE (PHLEBOTOMIST/MEDICAL)
Entity type:Individual
Prefix:MISS
First Name:GLENDA
Middle Name:DENISE
Last Name:WHITE
Suffix:
Gender:F
Credentials:PHLEBOTOMIST/MEDICAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 W 7TH ST APT 407
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-4710
Mailing Address - Country:US
Mailing Address - Phone:682-417-5312
Mailing Address - Fax:817-386-7943
Practice Address - Street 1:410 W 7TH ST APT 407
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-4710
Practice Address - Country:US
Practice Address - Phone:682-417-5312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23-7717247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other