MEDICARE: COURTNEY ERIN GLENN CNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	71012931A	IN

General Provider Information

NPI Number	:	1598483406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY ERIN GLENN CNP

Provider Business Mailing Address
First Line	:	28208 STATE ROUTE 1 STE 101
Second Line	:
City	:	WEST HARRISON
State	:	IN
Zip	:	47060-9410
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	28208 STATE ROUTE 1
Second Line	:
City	:	WEST HARRISON
State	:	IN
Zip	:	47060-9686
Country	:	US
Telephone Number	:	812-576-1600
Fax Number	:

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

Provider Enumeration Date	:	08/16/2022
Last Update Date	:	08/16/2022

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