Basic Information
| Provider Information | |||||||||
| NPI: | 1881602928 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PETRIE | ||||||||
| FirstName: | GLENDA | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | ARNP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | SPEEGLE | ||||||||
| OtherFirstName: | GLENDA | ||||||||
| OtherMiddleName: | P | ||||||||
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| OtherCredential: | ARNP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 732 SUMMITVIEW AVE | ||||||||
| Address2: | #621 | ||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989023032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095733448 | ||||||||
| FaxNumber: | 5095744481 | ||||||||
| Practice Location | |||||||||
| Address1: | 209 S 12TH AVE | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989023110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095774600 | ||||||||
| FaxNumber: | 5095774619 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 03/17/2011 | ||||||||
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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 | 363L00000X | AP30005625 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.