Individual
VERLYN GLENN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
1833 S MILLENIUM WAY STE 100, MERIDIAN, ID 83642-1510
(509) 828-8307
Mailing address
1711 W WOOD CHIP ST, MERIDIAN, ID 83642-7322
(509) 828-8307
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
66417
ID
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2861262
ID
Other
Enumeration date
02/08/2024
Last updated
07/13/2024
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