Basic Information
| Provider Information | |||||||||
| NPI: | 1760508790 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLEBROOK | ||||||||
| FirstName: | GLENDA | ||||||||
| MiddleName: | WATSON | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 CARBONTON RD | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273304009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197746521 | ||||||||
| FaxNumber: | 9197767179 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 CARBONTON RD | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273304009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197746521 | ||||||||
| FaxNumber: | 9197766179 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 09/15/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 49609 | NC | Y | Nursing Service Providers | Registered Nurse |
No ID Information.