Provider Demographics
NPI:1083757090
Name:GLENN, JULIE SHANNON (RN)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:SHANNON
Last Name:GLENN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:JULIE
Other - Middle Name:SHANNON
Other - Last Name:BISHOP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:154 BLOUNTVILLE BYPASS
Mailing Address - Street 2:
Mailing Address - City:BLOUNTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37617
Mailing Address - Country:US
Mailing Address - Phone:423-279-2777
Mailing Address - Fax:423-279-2797
Practice Address - Street 1:154 BLOUNTVILLE BYPASS
Practice Address - Street 2:
Practice Address - City:BLOUNTVILLE
Practice Address - State:TN
Practice Address - Zip Code:37617
Practice Address - Country:US
Practice Address - Phone:423-279-2777
Practice Address - Fax:423-279-2797
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000118144163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB58933Medicare UPIN
TN3170197Medicare ID - Type UnspecifiedMEDICARE NUMBER FOR BLTV.