Provider Demographics
NPI:1003544503
Name:GLASER, SHAYNA MARIE
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:MARIE
Last Name:GLASER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-8668
Mailing Address - Country:US
Mailing Address - Phone:701-215-6855
Mailing Address - Fax:
Practice Address - Street 1:414 4TH AVE NE
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2458
Practice Address - Country:US
Practice Address - Phone:701-215-6855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist