Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 5101019716 | MI |
NPI | 1013272350 |
---|---|
Provider Name | Dr. Kristina Elizabeth Glover |
First Address | Detroit, MI 48202-3450 |
Second Address | Colorado Springs, CO 80909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2012 |
Last Update Date | 19/07/2018 |