Provider Demographics
NPI:1073858981
Name:GLOVER, HEIDI (HEIDI GLOVER)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:GLOVER
Suffix:
Gender:F
Credentials:HEIDI GLOVER
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:GLOVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP BC
Mailing Address - Street 1:55 LAKE AVE NORTH DEPT. OF PEDI-ADOLESCENT
Mailing Address - Street 2:U MASS MEMORIAL MEDICAL CENTER, UNIVERSITY CAMPUS,
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01655
Mailing Address - Country:US
Mailing Address - Phone:744-442-5624
Mailing Address - Fax:
Practice Address - Street 1:55 LAKE AVE NORTH DEPT. OF PEDI-ADOLESCENT
Practice Address - Street 2:UMMC UNIVERSITY CAMPUS
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655
Practice Address - Country:US
Practice Address - Phone:744-442-5624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226121363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily