Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 0024167659 | VA |
NPI | 1093021537 |
---|---|
Provider Name | Ms. Carol D Glismann |
First Address | Leesburg, VA 20175-3922 |
Second Address | Leesburg, VA 20175-3922 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2010 |
Last Update Date | 03/01/2014 |