NPIMap

Individual provider Active NPI

Dominique Danielle Glenn, MSN, AGACNP-BC

  • Adult Health Nurse Practitioner
  • Greenville, SC
National Provider Identifier
1548139850
Registry record updated Apr 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
31139 Issued in SC
Practice address
48 Centennial Way
Greenville, SC 29605-4662
Phone
(864) 522-8000
NPI assigned
Nov 4, 2025
Last updated
Apr 22, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 22, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 31139 SC
Adult Health Nurse Practitioner 363LA2200X 31139 SC Primary

Addresses

Primary practice location

48 Centennial Way
Greenville, SC 29605-4662

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842

Other practice location 1

800 S Buncombe Rd
Greer, SC 29650-2400
Phone (864) 797-8500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260407001632 SC Practitioner - Nurse Practitioner 4880169937 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

48 Centennial Way
Greenville, SC 29605-4627
Phone (864) 522-8005

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 39

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 39

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1762214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776816000000",
    "number": "1548139850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 CENTENNIAL WAY",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054662",
            "telephone_number": "864-522-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 S Buncombe Rd",
            "address_purpose": "LOCATION",
            "city": "Greer",
            "state": "SC",
            "postal_code": "296502400",
            "country_code": "US",
            "telephone_number": "864-797-8500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GLENN",
        "first_name": "DOMINIQUE",
        "middle_name": "DANIELLE",
        "credential": "MSN, AGACNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-11-04",
        "last_updated": "2026-04-22",
        "certification_date": "2026-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "SC",
            "license": "31139",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "SC",
            "license": "31139",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.