Provider Demographics
NPI:1417779067
Name:SCHUBERT, GLENDA
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:
Last Name:SCHUBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E CENTRAL AVE SPC 41
Mailing Address - Street 2:
Mailing Address - City:SUTHERLIN
Mailing Address - State:OR
Mailing Address - Zip Code:97479-8805
Mailing Address - Country:US
Mailing Address - Phone:510-861-3003
Mailing Address - Fax:
Practice Address - Street 1:1000 E CENTRAL AVE SPC 41
Practice Address - Street 2:
Practice Address - City:SUTHERLIN
Practice Address - State:OR
Practice Address - Zip Code:97479-8805
Practice Address - Country:US
Practice Address - Phone:510-861-3003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider