Basic Information
| Provider Information | |||||||||
| NPI: | 1548649536 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GLENNON | ||||||||
| FirstName: | KIMBERLEE | ||||||||
| MiddleName: | KEREE | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1135 MORTON ST | ||||||||
| Address2: | |||||||||
| City: | MATTAPAN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021262834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175332346 | ||||||||
| FaxNumber: | 6175332341 | ||||||||
| Practice Location | |||||||||
| Address1: | 735 ATTUCKS LN | ||||||||
| Address2: | |||||||||
| City: | HYANNIS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026011867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087785420 | ||||||||
| FaxNumber: | 5087788747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2015 | ||||||||
| LastUpdateDate: | 05/22/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 372500000X | RN200678 | MA | Y | Nursing Service Related Providers | Chore Provider |
No ID Information.