Provider Demographics
NPI:1366474298
Name:GLENN, DAWN A (NP)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:A
Last Name:GLENN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:A
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:300 20TH AVE N STE 403
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5180
Mailing Address - Country:US
Mailing Address - Phone:615-284-4029
Mailing Address - Fax:615-284-7501
Practice Address - Street 1:150 E SWAN ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37033-1446
Practice Address - Country:US
Practice Address - Phone:931-729-3091
Practice Address - Fax:931-729-0174
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8009363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4280866OtherBLUE CROSS/BLUE /SHIELD
TN4134504OtherBLUE CROSS BLUE SHIELD
TN3908096Medicaid
TN3908096Medicaid
TN3908095Medicare PIN