Provider Demographics
NPI:1275766651
Name:GLASS, KATHLEEN ZILLNER (ANP-BC)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ZILLNER
Last Name:GLASS
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12 CENTER ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-1769
Mailing Address - Country:US
Mailing Address - Phone:716-679-2233
Mailing Address - Fax:716-672-4163
Practice Address - Street 1:12 CENTER ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-1769
Practice Address - Country:US
Practice Address - Phone:716-679-2233
Practice Address - Fax:716-672-4163
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF304889-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health