Healthcare Provider Details

I. General information

NPI: 1881518884
Provider Name (Legal Business Name): ANN ROSE GLENN MSN, APRN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W 5400 S
MURRAY UT
84107-5894
US

IV. Provider business mailing address

250 BROADWAY APT 509
REVERE MA
02151-5044
US

V. Phone/Fax

Practice location:
  • Phone: 801-747-8700
  • Fax: 801-747-8701
Mailing address:
  • Phone: 801-450-8171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number14301853-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: