Provider Demographics
NPI:1205838893
Name:GLASCOCK, CAROL ANN (APNP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:GLASCOCK
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:HEARN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:723 STATION XING
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-1886
Mailing Address - Country:US
Mailing Address - Phone:618-939-1551
Mailing Address - Fax:618-939-1553
Practice Address - Street 1:723 STATION XING
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-1886
Practice Address - Country:US
Practice Address - Phone:618-939-1551
Practice Address - Fax:618-939-1553
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-000-156363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner