Provider Demographics
NPI:1386021400
Name:FINCH, GLENN MICAH (MSN, RN, FNP)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:MICAH
Last Name:FINCH
Suffix:
Gender:
Credentials:MSN, RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1168 S AMITY LN
Mailing Address - Street 2:
Mailing Address - City:EAGAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85925-0017
Mailing Address - Country:US
Mailing Address - Phone:928-245-9857
Mailing Address - Fax:
Practice Address - Street 1:606 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EAGAR
Practice Address - State:AZ
Practice Address - Zip Code:85925-9815
Practice Address - Country:US
Practice Address - Phone:928-333-7333
Practice Address - Fax:928-333-7157
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7888363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ033179Medicaid