Healthcare Provider Details

I. General information

NPI: 1316011653
Provider Name (Legal Business Name): GLENDA ANN MCCONNELL PMHNP, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 6TH ST
GREEN BAY WI
54304-2252
US

IV. Provider business mailing address

1499 6TH ST
GREEN BAY WI
54304-2252
US

V. Phone/Fax

Practice location:
  • Phone: 920-497-6161
  • Fax: 888-974-5769
Mailing address:
  • Phone: 920-497-6161
  • Fax: 888-974-5769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2515-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number102105-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: