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General NPI Number Information
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NPI Number | 1295194538
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Entity Type | Individual
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Provider Name | CAMILLA GLENN MSN, RN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/15/2016
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Last Update Date | 08/30/2022
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Provider Practice Location Address
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Address Line | 1120 W LOOP 289 STE 230
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City | LUBBOCK
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State | TX
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Zip | 79416-4534
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Country | US
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Telephone | 68-744-8600
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Fax | 806-744-0072
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Provider Business Mailing Address
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Address Line | 1120 W LOOP 289 STE 230
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City | LUBBOCK
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State | TX
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Zip | 79416-4534
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Country | US
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Telephone | 806-744-8600
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Fax | 806-782-0097
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP129877
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License Number State | TX
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