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NPI Code Detail

MEDICARE: GLENDA ANN MCCONNELL PMHNP, BC

MEDICARE: GLENDA ANN MCCONNELL PMHNP, BC
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
1163WP0807XChild & Adolescent Psychiatric/Mental Health Registered Nurse102105-30WI
2363LP0808XPsychiatric/Mental Health Nurse Practitioner2515-33WI

General Provider Information

NPI Number : 1316011653
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLENDA ANN MCCONNELL PMHNP, BC
Provider Business Mailing Address
First Line : 1499 6TH ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54304-2252
Country : US
Telephone Number : 920-497-6161
Fax Number : 888-974-5769
Provider Business Practice Location Address
First Line : 1499 6TH ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54304-2252
Country : US
Telephone Number : 920-497-6161
Fax Number : 888-974-5769
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2006
Last Update Date : 08/27/2025

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