Provider Demographics
NPI:1871201772
Name:GLISSON, LINDA VENNEROD (LPN)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:VENNEROD
Last Name:GLISSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4970 PECK HILL RD
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078-9532
Mailing Address - Country:US
Mailing Address - Phone:315-446-8967
Mailing Address - Fax:
Practice Address - Street 1:4970 PECK HILL RD
Practice Address - Street 2:
Practice Address - City:JAMESVILLE
Practice Address - State:NY
Practice Address - Zip Code:13078-9532
Practice Address - Country:US
Practice Address - Phone:315-446-8967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173086-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse