| Doctor Name: | MISS SAMONE DOROTHEA GLENN |
| NPI Number: | 1073941860 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 71004688A |
| Business Practice Address: | 1466 W Oak St Zionsville, IN - 460771800 |
| Business Phone Number: | 3178736438 |
| Business Fax Number: | |
| Mailing Address: | 1704 Somerset Pl Apt 3, LOUISVILLE |
| State: | KY |
| Postal Code: | 402203739 |
| Phone Number: | 3178736438 |
| Fax Number: | |
| NPI Enumeration Date: | 10/15/2013 |
| NPI Last Update Date: | 10/19/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 71004688A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |