Provider Demographics
NPI:1235641143
Name:OLLIS, GLEN EDWARD (NP)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:EDWARD
Last Name:OLLIS
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:9 INDUSTRIAL RD STE 5
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3736
Mailing Address - Country:US
Mailing Address - Phone:508-473-1480
Mailing Address - Fax:508-473-1210
Practice Address - Street 1:1280 W CENTRAL ST STE 301
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-3110
Practice Address - Country:US
Practice Address - Phone:508-528-2700
Practice Address - Fax:508-528-5759
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2022-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MARN285099363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner