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General NPI Number Information
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NPI Number | 1639232424
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Entity Type | Individual
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Provider Name | RENEE YVETTE GLANVILLE L.M.P.
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Gender | Female
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6515 12TH AVE NE
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City | SEATTLE
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State | WA
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Zip | 98115-6753
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Country | US
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Telephone | 206-335-4974
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Fax | 425-361-1730
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Provider Business Mailing Address
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Address Line | 117 E LOUISA ST PMB 273
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City | SEATTLE
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State | WA
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Zip | 98102-3203
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Country | US
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Telephone | 206-335-4974
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Fax | 425-361-1730
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MA00007117
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License Number State | WA
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