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NPI Code Detail

MEDICARE: MRS. ROMIKA TANELLE GLENN RN, MSN, NP-C

MEDICARE: MRS. ROMIKA TANELLE GLENN RN, MSN, NP-C
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
1163W00000XRegistered Nurse4704218454MI
2363LF0000XFamily Nurse Practitioner4704218454MI

General Provider Information

NPI Number : 1346550753
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ROMIKA TANELLE GLENN RN, MSN, NP-C
Provider Business Mailing Address
First Line : 8864 GROVER ST
Second Line :
City : ROMULUS
State : MI
Zip : 48174-4124
Country : US
Telephone Number : 734-331-2494
Fax Number :
Provider Business Practice Location Address
First Line : 2025 FORT ST
Second Line :
City : WYANDOTTE
State : MI
Zip : 48192-3841
Country : US
Telephone Number : 734-320-0525
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2010
Last Update Date : 02/07/2020

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