Individual
GLENNETTE HANEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
100 MEDICAL DRIVE, ALTON, MO 65606-0468
(417) 778-7227
(417) 778-7727
Mailing address
PO BOX 1100, WEST PLAINS, MO 65775-1100
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
121404
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
199440758
—
AR
05
—
597843309
—
MO
Enumeration date
01/16/2007
Last updated
04/05/2018
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