Provider Demographics
NPI:1225549199
Name:GLASS, WENDY KAY (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:KAY
Last Name:GLASS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 183
Mailing Address - Street 2:
Mailing Address - City:CLEARBROOK
Mailing Address - State:MN
Mailing Address - Zip Code:56634-4241
Mailing Address - Country:US
Mailing Address - Phone:218-776-3508
Mailing Address - Fax:218-776-3507
Practice Address - Street 1:221 3RD AVE SW
Practice Address - Street 2:
Practice Address - City:CLEARBROOK
Practice Address - State:MN
Practice Address - Zip Code:56634-4241
Practice Address - Country:US
Practice Address - Phone:218-776-3508
Practice Address - Fax:218-776-3507
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1440614OtherRN LICENSE NUMBER