Provider Demographics
NPI:1073658787
Name:GLASSER, WONDA JEAN (CNA)
Entity Type:Individual
Prefix:
First Name:WONDA
Middle Name:JEAN
Last Name:GLASSER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 RED CANYON RD
Mailing Address - Street 2:P.O. BOX 83
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-8828
Mailing Address - Country:US
Mailing Address - Phone:719-252-6013
Mailing Address - Fax:
Practice Address - Street 1:510 N 19TH ST LOT 48
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-2467
Practice Address - Country:US
Practice Address - Phone:719-252-6013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO513342374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide