Provider Demographics
NPI:1518936426
Name:GLAESNER, EDWARD JULIAN (FNP)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:JULIAN
Last Name:GLAESNER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1617 N MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-9021
Mailing Address - Country:US
Mailing Address - Phone:919-577-9952
Mailing Address - Fax:919-577-9946
Practice Address - Street 1:1617 N MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-9021
Practice Address - Country:US
Practice Address - Phone:919-577-9952
Practice Address - Fax:919-577-9946
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201867363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC201867OtherNC LICENSE