Healthcare Provider Details

I. General information

NPI: 1811002264
Provider Name (Legal Business Name): GLENDA JEAN MORRIS RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 WEST 10TH STREET
ST. PAUL MN
55102
US

IV. Provider business mailing address

45 WEST 10TH STREET
ST. PAUL MN
55102
US

V. Phone/Fax

Practice location:
  • Phone: 651-326-2328
  • Fax:
Mailing address:
  • Phone: 651-476-2623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR080367-6
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0102602
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: