Provider Demographics
NPI:1427528926
Name:GLENN, MAKESHA DEANN
Entity type:Individual
Prefix:
First Name:MAKESHA
Middle Name:DEANN
Last Name:GLENN
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 1:15081 BROOKSTONE DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:TX
Mailing Address - Zip Code:75762-2717
Mailing Address - Country:US
Mailing Address - Phone:903-283-8595
Mailing Address - Fax:
Practice Address - Street 1:15081 BROOKSTONE DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:TX
Practice Address - Zip Code:75762-2717
Practice Address - Country:US
Practice Address - Phone:903-283-8595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX905746163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse