Healthcare Provider Details

I. General information

NPI: 1083419618
Provider Name (Legal Business Name): CATHERINE LORRAINE GLENN REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 WALNUT HILL LN
DALLAS TX
75231-4402
US

IV. Provider business mailing address

8200 WALNUT HILL LN
DALLAS TX
75231-4402
US

V. Phone/Fax

Practice location:
  • Phone: 214-345-6886
  • Fax:
Mailing address:
  • Phone: 214-345-6886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number724347
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: