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General NPI Number Information
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NPI Number | 1548037971
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Entity Type | Individual
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Provider Name | PHOENICIA GLINN
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Gender | Female
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Dates
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Enumeration Date | 12/06/2023
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 54 HILLSDALE RD
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48302-0633
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Country | US
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Telephone | 248-854-4369
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Fax |
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Provider Business Mailing Address
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Address Line | 54 HILLSDALE RD
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48302-0633
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Country | US
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Telephone | 248-854-4369
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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 | 156FC0801X
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Taxonomy Name | Contact Lens Fitter
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 156FX1202X
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Taxonomy Name | Optometric Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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