Healthcare Provider Details

I. General information

NPI: 1114546124
Provider Name (Legal Business Name): GLENDA LYNN DENNIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1859 RAMBLING DR
SPRINGFIELD OR
97477-2417
US

IV. Provider business mailing address

1859 RAMBLING DR
SPRINGFIELD OR
97477-2417
US

V. Phone/Fax

Practice location:
  • Phone: 541-505-7386
  • Fax:
Mailing address:
  • Phone: 541-505-7386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number000031876RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: