Basic Information
| Provider Information | |||||||||
| NPI: | 1740218726 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLENN | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | JANE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LM | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 579 W CIRCLE RD | ||||||||
| Address2: | |||||||||
| City: | GRAY COURT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296456513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8643290010 | ||||||||
| FaxNumber: | 8642282221 | ||||||||
| Practice Location | |||||||||
| Address1: | 579 W CIRCLE RD | ||||||||
| Address2: | |||||||||
| City: | GRAY COURT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296456513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8643290010 | ||||||||
| FaxNumber: | 8642282221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | LMW-025 | SC | Y | Other Service Providers | Midwife |
No ID Information.