Provider Demographics
NPI:1639777881
Name:GLASSER, KELLY FAYE
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:FAYE
Last Name:GLASSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 MCKENZIE DR SE APT 203
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-6241
Mailing Address - Country:US
Mailing Address - Phone:701-667-1592
Mailing Address - Fax:
Practice Address - Street 1:4250 MCKENZIE DR SE APT 203
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-6241
Practice Address - Country:US
Practice Address - Phone:701-667-1592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-10
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant