MEDICARE: MS. MAUREEN P GLENDON MSN, ARNP,BC, CRNP

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	363LP0200X	Pediatric Nurse Practitioner	RN193224-L	PA

General Provider Information

NPI Number	:	1548301765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAUREEN P GLENDON MSN, ARNP,BC, CRNP

Provider Business Mailing Address
First Line	:	984 WESLEY AVE
Second Line	:
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-8622
Country	:	US
Telephone Number	:	215-379-1116
Fax Number	:

Provider Business Practice Location Address
First Line	:	11201 ACADEMY RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-3303
Country	:	US
Telephone Number	:	215-637-1800
Fax Number	:	215-637-8833

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	07/08/2007

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