Provider Demographics
NPI:1598021503
Name:MCGLASSON, DEBORAH ANN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:MCGLASSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 N TACOMA AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-3551
Mailing Address - Country:US
Mailing Address - Phone:317-426-2210
Mailing Address - Fax:317-779-2560
Practice Address - Street 1:5555 N TACOMA AVE
Practice Address - Street 2:STE 104
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-3551
Practice Address - Country:US
Practice Address - Phone:317-426-2210
Practice Address - Fax:317-779-2560
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28193517A163WC0400X, 251B00000X, 3747P1801X
IN71009915A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No251B00000XAgenciesCase Management
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant