| Doctor Name: | MR. GLEN MARVIN INTERMILL |
| NPI Number: | 1992877963 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CRNFA |
| License Number: | |
| Business Practice Address: | 1222 Craiglea Dr Eagle Point, OR - 975249617 |
| Business Phone Number: | 5415353820 |
| Business Fax Number: | 5415353821 |
| Mailing Address: | 1222 Craiglea Dr, EAGLE POINT |
| State: | OR |
| Postal Code: | 975249617 |
| Phone Number: | 5415353820 |
| Fax Number: | 5415353821 |
| NPI Enumeration Date: | 11/15/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WR0006X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Registered Nurse First Assistant |
| Taxonomy Definition: | A perioperative registered nurse who works in collaboration with the surgeon and other health care team members to achieve optimal outcomes. The RNFA has acquired the necessary knowledge, judgment, and skills specific to the expanded role of RNFA clinical practice. Intraoperatively, the RNFA assists the surgeon. |