Provider Demographics
NPI:1568853851
Name:GLASS, KIMBERLY APRIL (VOCATIONAL NURSE)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:APRIL
Last Name:GLASS
Suffix:
Gender:F
Credentials:VOCATIONAL NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16900 WOOD RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-9548
Mailing Address - Country:US
Mailing Address - Phone:909-496-5034
Mailing Address - Fax:
Practice Address - Street 1:3801 UNIVERSITY AVE STE 350
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3277
Practice Address - Country:US
Practice Address - Phone:909-496-5034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 197561164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVN 197561OtherLICENSED VOCATIONAL NURSE