Healthcare Provider Details

I. General information

NPI: 1063668564
Provider Name (Legal Business Name): ROBIN M GLENN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 08/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 N ELM ST
HENDERSON KY
42420-2715
US

IV. Provider business mailing address

415 W COLUMBIA ST
EVANSVILLE IN
47710-1656
US

V. Phone/Fax

Practice location:
  • Phone: 270-827-8811
  • Fax: 812-464-0565
Mailing address:
  • Phone: 812-464-0521
  • Fax: 812-464-0565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number109778
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number28165798A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: