Provider Demographics
NPI:1366586604
Name:GLENN, CORNELIA H (CRNA)
Entity type:Individual
Prefix:
First Name:CORNELIA
Middle Name:H
Last Name:GLENN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CORNELIA
Other - Middle Name:H
Other - Last Name:MCCANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1118 ROSS CLARK CIRCLE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3030
Mailing Address - Country:US
Mailing Address - Phone:334-793-5105
Mailing Address - Fax:334-671-5073
Practice Address - Street 1:1118 ROSS CLARK CIRCLE
Practice Address - Street 2:SUITE 700
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3030
Practice Address - Country:US
Practice Address - Phone:334-793-5105
Practice Address - Fax:334-671-5073
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-088200367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered