Healthcare Provider Details

I. General information

NPI: 1568827947
Provider Name (Legal Business Name): GLEN ROBERT DOPP JR. DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 03/02/2025
Certification Date: 03/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 RED ROCK DR
GALLUP NM
87301-5683
US

IV. Provider business mailing address

PO BOX 521
DEER RIVER MN
56636-0521
US

V. Phone/Fax

Practice location:
  • Phone: 505-863-7000
  • Fax:
Mailing address:
  • Phone: 218-301-9265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6398
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number77859
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR-229298-4
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR-229298-4
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR-229298-4
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberR-229298-4
License Number StateMN
# 7
Primary TaxonomyN
Taxonomy Code163WN0003X
TaxonomyLow-Risk Neonatal Registered Nurse
License NumberR-229298-4
License Number StateMN
# 8
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberR-229298-4
License Number StateMN
# 9
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberR-229298-4
License Number StateMN
# 10
Primary TaxonomyN
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License NumberR-229298-4
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: