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General NPI Number Information
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NPI Number | 1932738150
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Entity Type | Individual
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Provider Name | KATHLEEN GLENN CRNP
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Gender | Female
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Dates
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Enumeration Date | 04/08/2020
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 252 S 4TH ST
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City | LEBANON
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State | PA
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Zip | 17042-6111
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Country | US
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Telephone | 717-851-2613
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Fax | 717-798-3677
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Provider Business Mailing Address
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Address Line | 601 MEMORY LN
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City | YORK
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State | PA
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Zip | 17402-2231
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Country | US
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Telephone | 717-851-1405
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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 | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | SP016649
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | SP016649
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License Number State | PA
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