Healthcare Provider Details

I. General information

NPI: 1417106824
Provider Name (Legal Business Name): CHRISTEN GLENNAN RN, MS, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 N MAIN ST SUITE 1C
PRESCOTT VALLEY AZ
86314-1216
US

IV. Provider business mailing address

3001 N MAIN ST SUITE 1C
PRESCOTT VALLEY AZ
86314-1216
US

V. Phone/Fax

Practice location:
  • Phone: 928-458-5470
  • Fax: 928-458-5979
Mailing address:
  • Phone: 928-458-5470
  • Fax: 928-458-5979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP3128
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: