Healthcare Provider Details

I. General information

NPI: 1306005624
Provider Name (Legal Business Name): JENNIFER L GLEN DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER L MICHALSKI

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 S. NINTH ST DBA SALINA REGIONAL URGENT CARE
SALINA KS
67401
US

IV. Provider business mailing address

2265 S. NINTH ST DBA SALINA REGIONAL URGENT CARE
SALINA KS
67401
US

V. Phone/Fax

Practice location:
  • Phone: 785-452-6000
  • Fax: 785-452-6591
Mailing address:
  • Phone: 785-452-6000
  • Fax: 785-452-6591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5375694
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2005033658
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2005033658
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1499928
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: