Active NPI
Renee Yvette Glanville, L.M.P.
- Specialist
- Seattle, WA
National Provider Identifier
1639232424
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MA00007117
- Practice address
- 6515 12TH Ave NE
Seattle, WA 98115-6753 - Phone
- (206) 335-4974
- Fax
- (425) 361-1730
- NPI assigned
- Dec 19, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MA00007117 | WA | Primary |
Addresses
Primary practice location
6515 12TH Ave NE
Seattle, WA 98115-6753
Mailing address
117 E Louisa St
PMB 273
Seattle, WA 98102-3203
Phone (206) 335-4974
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 208207224735 | Other | WA | PREMERA BLUE CROSS |
| 50290 | Other | WA | LABOR AND INDUSTRY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA00007117 | WA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1639232424",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "117 E LOUISA ST",
"address_2": "PMB 273",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981023203",
"telephone_number": "206-335-4974",
"fax_number": "425-361-1730"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6515 12TH AVE NE",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981156753",
"telephone_number": "206-335-4974",
"fax_number": "425-361-1730"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLANVILLE",
"first_name": "RENEE",
"middle_name": "YVETTE",
"credential": "L.M.P.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WA",
"license": "MA00007117",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREMERA BLUE CROSS",
"identifier": "208207224735",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR AND INDUSTRY",
"identifier": "50290",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.