Provider Demographics
NPI:1578005385
Name:GLASSFORD, DANIEL (RN)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:GLASSFORD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 HARNESS DR
Mailing Address - Street 2:
Mailing Address - City:POPE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94567-9424
Mailing Address - Country:US
Mailing Address - Phone:707-971-9227
Mailing Address - Fax:
Practice Address - Street 1:2709 HARNESS DR
Practice Address - Street 2:
Practice Address - City:POPE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94567-9424
Practice Address - Country:US
Practice Address - Phone:707-971-9227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95107920163W00000X
GA254542163W00000X
TN207565163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse