Provider Demographics
NPI:1063739621
Name:GLENN, JOSPEH W (NP-C)
Entity type:Individual
Prefix:
First Name:JOSPEH
Middle Name:W
Last Name:GLENN
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 33194
Mailing Address - Street 2:
Mailing Address - City:FORT LEWIS
Mailing Address - State:WA
Mailing Address - Zip Code:98433-0194
Mailing Address - Country:US
Mailing Address - Phone:216-702-6833
Mailing Address - Fax:253-968-3474
Practice Address - Street 1:9040 JACKSON AVE
Practice Address - Street 2:MADIGAN ARMY MEDICAL CENTER WTB CLINIC
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-5000
Practice Address - Country:US
Practice Address - Phone:785-239-7582
Practice Address - Fax:785-239-7364
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-22
Last Update Date:2012-11-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARA02941363LA2200X
OHCOA 09013-NP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care