Provider Demographics
NPI:1598271793
Name:GLASER, JACLYN L (PA-C)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:L
Last Name:GLASER
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2025 SLOAN PL STE 35
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2092
Mailing Address - Country:US
Mailing Address - Phone:651-772-1572
Mailing Address - Fax:651-772-1889
Practice Address - Street 1:7180 10TH ST N
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-1122
Practice Address - Country:US
Practice Address - Phone:651-242-5890
Practice Address - Fax:651-731-6207
Is Sole Proprietor?:No
Enumeration Date:2017-12-26
Last Update Date:2019-04-23
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Provider Licenses
StateLicense IDTaxonomies
MN12598363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant