Provider Demographics
NPI:1932392958
Name:KNIGHT, GLENDA ELAINE (RN)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:ELAINE
Last Name:KNIGHT
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 1:29556 TAWAS ST
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-5421
Mailing Address - Country:US
Mailing Address - Phone:248-336-9517
Mailing Address - Fax:
Practice Address - Street 1:29556 TAWAS ST
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-5421
Practice Address - Country:US
Practice Address - Phone:248-336-9517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704096372163WG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0100XNursing Service ProvidersRegistered NurseGastroenterology