Provider Demographics
NPI:1396332235
Name:HALL, GLENDA (NP)
Entity type:Individual
Prefix:MISS
First Name:GLENDA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11110 EAST FWY STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77029-1914
Mailing Address - Country:US
Mailing Address - Phone:713-450-3505
Mailing Address - Fax:713-451-4321
Practice Address - Street 1:11110 EAST FWY STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77029-1914
Practice Address - Country:US
Practice Address - Phone:713-450-3505
Practice Address - Fax:713-451-4321
Is Sole Proprietor?:No
Enumeration Date:2020-12-27
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1034327363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology