Provider Demographics
NPI:1548037971
Name:GLINN, PHOENICIA
Entity type:Individual
Prefix:
First Name:PHOENICIA
Middle Name:
Last Name:GLINN
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 1:54 HILLSDALE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0633
Mailing Address - Country:US
Mailing Address - Phone:248-854-4369
Mailing Address - Fax:
Practice Address - Street 1:54 HILLSDALE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0633
Practice Address - Country:US
Practice Address - Phone:248-854-4369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter
No156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric Technician
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No172A00000XOther Service ProvidersDriver
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No251E00000XAgenciesHome Health
No347C00000XTransportation ServicesPrivate Vehicle