Provider Demographics
NPI:1164664736
Name:GLASS, ELIZABETH ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:GLASS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ARBOR CIR
Mailing Address - Street 2:APT 1425
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-5811
Mailing Address - Country:US
Mailing Address - Phone:513-843-4308
Mailing Address - Fax:
Practice Address - Street 1:14 ARBOR CIR
Practice Address - Street 2:APT 1425
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-5811
Practice Address - Country:US
Practice Address - Phone:513-843-4308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-29
Last Update Date:2009-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.118007164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse