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GLENDA PRUDENCIO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
12150 ANNAPOLIS RD STE 308, GLENN DALE, MD 20769-9183
(301) 805-0006
Mailing address
1440 CHANNING ST NE, WASHINGTON, DC 20018-2004
(301) 412-3702

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
0110-005091
VA
363AM0700X
Medical Physician Assistant
Primary
C05930
MD

Other

Enumeration date
08/30/2015
Last updated
09/20/2019
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