Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | A02941 | AR |
N | 363LP2300X | Nurse Practitioner - Primary Care | COA 09013-NP | OH |
NPI | 1063739621 |
---|---|
Provider Name | Jospeh W Glenn |
First Address | Fort Lewis, WA 98433-0194 |
Second Address | Tacoma, WA 98431-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2010 |
Last Update Date | 05/11/2012 |