Individual
GLENN JEROME LANDRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
4950 ESSEN LN STE 503, BATON ROUGE, LA 70809-3738
(225) 765-1737
(225) 765-1842
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(225) 526-0011
(225) 765-9196
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
06368
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2141040
—
LA
05
—
2434045
—
MS
01
—
274780YJA2
MEDICARE
—
Enumeration date
02/25/2011
Last updated
12/29/2020
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