Healthcare Provider Details

I. General information

NPI: 1366474298
Provider Name (Legal Business Name): DAWN A GLENN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAWN A JAMES NP

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E SWAN ST
CENTERVILLE TN
37033-1446
US

IV. Provider business mailing address

300 20TH AVE N STE 403
NASHVILLE TN
37203-5180
US

V. Phone/Fax

Practice location:
  • Phone: 931-729-3091
  • Fax: 931-729-0174
Mailing address:
  • Phone: 615-284-4029
  • Fax: 615-284-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8009
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: