Individual
GLENN MICHAEL EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN/SRNA
Contact information
Practice address
130 W RAVINE RD, KINGSPORT, TN 37660-3837
(423) 224-4000
Mailing address
902 BROAD ST APT 6, KINGSPORT, TN 37660-3815
(423) 863-1872
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
220234
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
30283
TN
Other
Enumeration date
01/21/2021
Last updated
10/04/2021
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