Provider Demographics
NPI:1982242160
Name:GLENN, MICAH ERIN (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:ERIN
Last Name:GLENN
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 STATE ROUTE 522
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-8120
Mailing Address - Country:US
Mailing Address - Phone:740-574-1770
Mailing Address - Fax:740-574-8781
Practice Address - Street 1:1661 STATE ROUTE 522
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-8120
Practice Address - Country:US
Practice Address - Phone:740-574-1770
Practice Address - Fax:740-574-8781
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCNP.026039363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner