Provider Demographics
NPI:1932890928
Name:MACAS, GLENDA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:
Last Name:MACAS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WADE AVE
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4663
Mailing Address - Country:US
Mailing Address - Phone:410-887-5011
Mailing Address - Fax:410-494-2777
Practice Address - Street 1:309 REDWOOD CIR
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-5250
Practice Address - Country:US
Practice Address - Phone:410-852-6688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR199302163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management