Provider Demographics
NPI:1871633123
Name:QUIST, GLENNA (NP)
Entity type:Individual
Prefix:
First Name:GLENNA
Middle Name:
Last Name:QUIST
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 W 119TH ST STE 425
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3755
Mailing Address - Country:US
Mailing Address - Phone:913-492-4020
Mailing Address - Fax:913-722-4385
Practice Address - Street 1:5701 W 119TH ST STE 425
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3755
Practice Address - Country:US
Practice Address - Phone:913-492-4020
Practice Address - Fax:913-722-4385
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS44840363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP12692Medicare UPIN