Basic Information
| Provider Information | |||||||||
| NPI: | 1518936863 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLYN | ||||||||
| FirstName: | JANENE | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1285 NININGER RD | ||||||||
| Address2: | |||||||||
| City: | HASTINGS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550331086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514804200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1285 NININGER RD | ||||||||
| Address2: | |||||||||
| City: | HASTINGS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550331086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514804200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 01/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 8620A | WY | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 42887 | MN | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 127968 | 01 | MN | UCARE MINNESOTA | OTHER | 34005200 | 01 | MN | MEDICAID WI | OTHER | 34005200 | 01 | MN | GROUP HEALTH EAU CLAIRE | OTHER | HP31065 | 01 | MN | HEALTH PARTNERS | OTHER | 12-00895 | 01 | MN | MEDICA | OTHER | 66-07835 | 01 | MN | MEDICA URGENT CARE | OTHER | 190150800 | 05 | MN | MEDICAID | 27F14GL | 01 | MN | BLUE CROSS | OTHER | 370020464 | 01 | MN | RAILROAD MEDICARE | OTHER | NA9141025070 | 01 | MN | PREFERRED ONE | OTHER | 1072689 | 01 | MN | AMERICA'S PPO | OTHER |