MEDICARE: CYNTHIA JANE GLENN LM

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	176B00000X	Midwife	LMW-025	SC

General Provider Information

NPI Number	:	1740218726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA JANE GLENN LM

Provider Business Mailing Address
First Line	:	111 COMMONS WAY
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29611-3850
Country	:	US
Telephone Number	:	864-329-0010
Fax Number	:	864-373-9063

Provider Business Practice Location Address
First Line	:	111 COMMONS WAY
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29611-3850
Country	:	US
Telephone Number	:	864-329-0010
Fax Number	:	864-373-9063

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	02/28/2024

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