Provider Demographics
NPI:1730407479
Name:GLENNON, CECELIA SHEPHERD (NP, RN)
Entity type:Individual
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First Name:CECELIA
Middle Name:SHEPHERD
Last Name:GLENNON
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Gender:F
Credentials:NP, RN
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Mailing Address - Street 1:300 PASTEUR DR
Mailing Address - Street 2:SUMC - PEDS PHYSICIAN BILLING MC: 5530
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:650-498-7391
Mailing Address - Fax:650-725-7888
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:SUMC - PEDS PHYSICIAN BILLING MC: 5530
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-498-7391
Practice Address - Fax:650-725-7888
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2012-09-26
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Provider Licenses
StateLicense IDTaxonomies
CANP7406363LP0200X
CA461450363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics