Provider Demographics
NPI:1457668527
Name:GLASS, STEPHANIE J (RCNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:GLASS
Suffix:
Gender:F
Credentials:RCNP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:J
Other - Last Name:ECKEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RCNP
Mailing Address - Street 1:495 COOPER RD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8710
Mailing Address - Country:US
Mailing Address - Phone:614-839-5555
Mailing Address - Fax:614-839-5100
Practice Address - Street 1:495 COOPER RD
Practice Address - Street 2:SUITE 420
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8710
Practice Address - Country:US
Practice Address - Phone:614-839-5555
Practice Address - Fax:614-839-5100
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 02747 NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health