Individual
LUCILLE W GLENN
Active
Individual
LUCILLE W GLENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD00023849
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0038587
LABOR & INDUSTRY
WA
01
—
300042305
RAILROAD MEDICARE
WA
01
—
806277300
INDAHO MEDICAID
WA
05
—
8117467
—
WA
01
—
GL5250
BLUE SHIELD
WA
01
—
MD430WA
ALASKA MEDICAID
WA
01
—
US0863569
AETNA/USHC SPECIALIST
WA
Enumeration date
07/20/2006
Last updated
06/17/2008
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