Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 63858 | WV |
NPI | 1023450004 |
---|---|
Provider Name | Christy Lynn Glass |
First Address | Morgantown, WV 26505-1876 |
Second Address | Morgantown, WV 26505-1876 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2013 |
Last Update Date | 19/07/2013 |