Healthcare Provider Details

I. General information

NPI: 1639943673
Provider Name (Legal Business Name): GLENNA EMILY JAMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 HYSLIP FORD RD
BUNKER HILL WV
25413-4030
US

IV. Provider business mailing address

545 HYSLIP FORD RD
BUNKER HILL WV
25413-4030
US

V. Phone/Fax

Practice location:
  • Phone: 240-310-9123
  • Fax:
Mailing address:
  • Phone: 240-310-9123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: