Provider Demographics
NPI:1295017184
Name:GLOVER, LAURIE L (APRN, CPNP)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:L
Last Name:GLOVER
Suffix:
Gender:F
Credentials:APRN, CPNP
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:L
Other - Last Name:MERCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-0458
Mailing Address - Country:US
Mailing Address - Phone:641-684-6896
Mailing Address - Fax:641-226-5759
Practice Address - Street 1:201 S MARKET ST
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2924
Practice Address - Country:US
Practice Address - Phone:641-684-6896
Practice Address - Fax:641-226-5759
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC070073363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA16064Medicare PIN