Provider Demographics
NPI:1427328798
Name:GLENN, MEGAN LESLEY (PA-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LESLEY
Last Name:GLENN
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1820 SALTONSTALL DR
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-9354
Mailing Address - Country:US
Mailing Address - Phone:630-247-8497
Mailing Address - Fax:309-624-8820
Practice Address - Street 1:3024 E EMPIRE ST STE EANDF
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-5402
Practice Address - Country:US
Practice Address - Phone:309-451-3376
Practice Address - Fax:309-452-3376
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2023-03-13
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Provider Licenses
StateLicense IDTaxonomies
IL085.004236363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant