Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | F380947 | NY |
NPI | 1003909755 |
---|---|
Provider Name | Angela Glasscock |
First Address | Brooklyn, NY 11206 |
Second Address | Brooklyn, NY 11205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 27/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00246075 | (05) | NY |