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General NPI Number Information
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NPI Number | 1518168988
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Entity Type | Individual
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Provider Name | DEBORA JANE GLENN APRN-BC-WCC
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Gender | Female
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1822 SAVANNAH HWY
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City | CHARLESTON
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State | SC
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Zip | 29407-6253
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Country | US
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Telephone | 888-605-4222
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Fax |
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Provider Business Mailing Address
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Address Line | 1328 SALT MARSH CV
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City | CHARLESTON
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State | SC
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Zip | 29412-8414
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Country | US
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Telephone | 843-795-8806
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Fax |
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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 | 1701
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License Number State | SC
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