Provider Demographics
NPI:1487980918
Name:GLENNON, HOLLY (RN, LMP, CERTIFIED R)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:GLENNON
Suffix:
Gender:F
Credentials:RN, LMP, CERTIFIED R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 W BAY DR NW STE 208B
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4310
Mailing Address - Country:US
Mailing Address - Phone:360-528-0683
Mailing Address - Fax:
Practice Address - Street 1:1801 W BAY DR NW STE 208-B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4310
Practice Address - Country:US
Practice Address - Phone:360-528-0683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-17
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
173C00000X
WARN60078268163W00000X
WAMA60083520163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No173C00000XOther Service ProvidersReflexologist
No163W00000XNursing Service ProvidersRegistered Nurse