Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 6399 | CA |
NPI | 1053480046 |
---|---|
Provider Name | Ms. Vanessa E Glaze |
First Address | Visalia, CA 93291-6237 |
Second Address | Exeter, CA 93221-1312 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 23/10/2015 |