Provider Demographics
NPI:1457451072
Name:COLGLAZIER, JODY RULLMAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:JODY
Middle Name:RULLMAN
Last Name:COLGLAZIER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:JODY
Other - Middle Name:MARIE
Other - Last Name:RULLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1660 S COLUMBIAN WAY
Mailing Address - Street 2:SEA-111-HBPC
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1532
Mailing Address - Country:US
Mailing Address - Phone:206-764-2173
Mailing Address - Fax:
Practice Address - Street 1:1660 S COLUMBIAN WAY
Practice Address - Street 2:SEA-111-HBPC
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-764-2173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00103486163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARN 00103486OtherRN LICENCE