Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | F320035-1 | NY |
NPI | 1669548715 |
---|---|
Provider Name | Judith Glover |
First Address | Mc Donough, NY 13801-3102 |
Second Address | Norwich, NY 13815-1019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02199897 | (05) | NY |
P53819-UPIN | (02) | NY |