Healthcare Provider Details

I. General information

NPI: 1205498268
Provider Name (Legal Business Name): GLENN CHRISTOPHER CLINE APRN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2019
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 TECH CENTER DR
GAHANNA OH
43230-1987
US

IV. Provider business mailing address

1520 W 6TH AVE APT 19
COLUMBUS OH
43212-2469
US

V. Phone/Fax

Practice location:
  • Phone: 143-962-6846
  • Fax: 614-396-2480
Mailing address:
  • Phone: 614-271-3081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.024927
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: