Provider Demographics
NPI:1275520694
Name:GLASER, LYNNE (RNP)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:
Last Name:GLASER
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 BROAD ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-6933
Mailing Address - Country:US
Mailing Address - Phone:401-726-1048
Mailing Address - Fax:401-724-0896
Practice Address - Street 1:525 BROAD ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-6933
Practice Address - Country:US
Practice Address - Phone:401-726-1048
Practice Address - Fax:401-724-0896
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP25135363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI405753OtherBLUECHIP
RI8002920Medicaid
RI508002920Medicare ID - Type Unspecified
RI8002920Medicaid