Individual
GLENN GEORGE CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ACNP
Contact information
Practice address
601 JOHN ST STE M-510, KALAMAZOO, MI 49007-5341
(269) 341-7762
Mailing address
601 JOHN ST, BOX 39, KALAMAZOO, MI 49007-5341
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
4704163322
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003822412
BCBS - BRONSON
MI
05
—
1609103589
—
MI
Enumeration date
11/12/2009
Last updated
03/03/2022
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