Provider Demographics
NPI:1568768216
Name:GLAVE, LAVERN ANGELA (ANP)
Entity Type:Individual
Prefix:
First Name:LAVERN
Middle Name:ANGELA
Last Name:GLAVE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PARK CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2945
Mailing Address - Country:US
Mailing Address - Phone:914-843-6424
Mailing Address - Fax:845-341-1032
Practice Address - Street 1:3 PARK CIRCLE DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2945
Practice Address - Country:US
Practice Address - Phone:914-843-6424
Practice Address - Fax:845-341-1032
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY495182-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health