Healthcare Provider Details

I. General information

NPI: 1942962600
Provider Name (Legal Business Name): BRITTANY GLENN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 FORDLINE ST
SOUTHGATE MI
48195-2404
US

IV. Provider business mailing address

13800 FORDLINE ST
SOUTHGATE MI
48195-2404
US

V. Phone/Fax

Practice location:
  • Phone: 313-434-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704384774
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: