Healthcare Provider Details

I. General information

NPI: 1124095302
Provider Name (Legal Business Name): THERESA LYNN GLONNING FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28635 N NORTH VALLEY PKWY
PHOENIX AZ
85085-5434
US

IV. Provider business mailing address

7849 W LUDLOW DR
PEORIA AZ
85381-4665
US

V. Phone/Fax

Practice location:
  • Phone: 623-556-6973
  • Fax:
Mailing address:
  • Phone: 623-556-6973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP1349
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: