MEDICARE: MISS GLYNIS MICHELLE HAYWOOD LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	172360	CA
2	164W00000X	Licensed Practical Nurse	892111	NV

General Provider Information

NPI Number	:	1205786233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS GLYNIS MICHELLE HAYWOOD LPN

Provider Business Mailing Address
First Line	:	5111 PIONEER AVE APT 104
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-8184
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5111 PIONEER AVE APT 104
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-8184
Country	:	US
Telephone Number	:	951-237-9616
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2026
Last Update Date	:	01/29/2026

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