Provider Demographics
NPI:1164837589
Name:GLISSON, EMILY (NP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GLISSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8393 ELTA DRIVE
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-8714
Mailing Address - Country:US
Mailing Address - Phone:315-698-0290
Mailing Address - Fax:315-698-0291
Practice Address - Street 1:8393 ELTA DRIVE
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-8714
Practice Address - Country:US
Practice Address - Phone:315-698-0290
Practice Address - Fax:315-698-0291
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338789363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner