MEDICARE: DAWN A GLENN NP

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	363LF0000X	Family Nurse Practitioner	8009	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4280866	OTHER	TN	BLUE CROSS/BLUE /SHIELD
2	4134504	OTHER	TN	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366474298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN A GLENN NP

Provider Business Mailing Address
First Line	:	300 20TH AVE N STE 403
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-5180
Country	:	US
Telephone Number	:	615-284-4029
Fax Number	:	615-284-7501

Provider Business Practice Location Address
First Line	:	150 E SWAN ST
Second Line	:
City	:	CENTERVILLE
State	:	TN
Zip	:	37033-1446
Country	:	US
Telephone Number	:	931-729-3091
Fax Number	:	931-729-0174

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	10/22/2019

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