Provider Demographics
NPI:1275885097
Name:GLOVER, MARYCLAIRE (APN)
Entity Type:Individual
Prefix:
First Name:MARYCLAIRE
Middle Name:
Last Name:GLOVER
Suffix:
Gender:F
Credentials:APN
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8000
Mailing Address - Street 2:DEPT 601
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0002
Mailing Address - Country:US
Mailing Address - Phone:866-295-0041
Mailing Address - Fax:708-342-2517
Practice Address - Street 1:300 2ND AVE
Practice Address - Street 2:SUITE 021
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6303
Practice Address - Country:US
Practice Address - Phone:732-923-6091
Practice Address - Fax:732-923-6092
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2013-01-16
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Provider Licenses
StateLicense IDTaxonomies
NYF382240-1363LP0200X
NJ26NJ00407300363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics