Provider Demographics
NPI:1902687163
Name:GLENN, JANE MAE
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:MAE
Last Name:GLENN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7771 ALIVIA CIR
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-0895
Mailing Address - Country:US
Mailing Address - Phone:479-841-9881
Mailing Address - Fax:
Practice Address - Street 1:7771 ALIVIA CIR
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0895
Practice Address - Country:US
Practice Address - Phone:479-841-9881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide