Provider Demographics
NPI:1679965818
Name:GRICE, GLENNA
Entity type:Individual
Prefix:
First Name:GLENNA
Middle Name:
Last Name:GRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-8710
Mailing Address - Country:US
Mailing Address - Phone:985-735-1426
Mailing Address - Fax:985-735-1428
Practice Address - Street 1:1202 SUNSET DR
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-8710
Practice Address - Country:US
Practice Address - Phone:985-735-1426
Practice Address - Fax:985-735-1428
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program