Healthcare Provider Details

I. General information

NPI: 1841396132
Provider Name (Legal Business Name): GENWYL ANN GLOVER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 JEFFERSON AVENUE
MEMPHIS TN
38104
US

IV. Provider business mailing address

4735 BATEMAN ROAD
MILLINGTON TN
38109-3912
US

V. Phone/Fax

Practice location:
  • Phone: 901-523-8990
  • Fax:
Mailing address:
  • Phone: 901-873-1189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number035910
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: