Provider Demographics
NPI:1578860250
Name:GLOVER, MARCUS ANTHONY (LPN)
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:ANTHONY
Last Name:GLOVER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 S COLE AVE
Mailing Address - Street 2:APT. 1H
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-5467
Mailing Address - Country:US
Mailing Address - Phone:845-300-9370
Mailing Address - Fax:
Practice Address - Street 1:40 S COLE AVE
Practice Address - Street 2:APT. 1H
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-5467
Practice Address - Country:US
Practice Address - Phone:845-300-9370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303810-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse