Provider Demographics
NPI:1528299534
Name:GLENNY, MIZPAH S (PA-C)
Entity type:Individual
Prefix:
First Name:MIZPAH
Middle Name:S
Last Name:GLENNY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-1726
Mailing Address - Country:US
Mailing Address - Phone:814-643-4415
Mailing Address - Fax:814-643-2620
Practice Address - Street 1:814 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-1726
Practice Address - Country:US
Practice Address - Phone:814-643-4415
Practice Address - Fax:814-643-2620
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053073363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical