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Individual

GARY B GLENN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 765-8585
Mailing address
2204 IRONWOOD PL STE B, COEUR D ALENE, ID 83814-2662
(208) 765-8585
(000) 000-0000

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
RN635391
CA
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA-706A
ID

Other

Enumeration date
11/29/2006
Last updated
04/29/2024
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