Provider Demographics
NPI:1659366078
Name:GLOVER, MIRIAM ARONA (CRNA)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:ARONA
Last Name:GLOVER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22926
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-2926
Mailing Address - Country:US
Mailing Address - Phone:713-400-2990
Mailing Address - Fax:713-400-2993
Practice Address - Street 1:1635 NORTH LOOP WEST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1593
Practice Address - Country:US
Practice Address - Phone:713-400-2990
Practice Address - Fax:713-400-2993
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX515470367500000X
TXAP101116367500000X
TXRN515470367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00232623OtherRAILROAD MEDICARE
TX037325OtherRECERTIFICATION AANA
TX146692214Medicaid
TX146692213Medicaid
TX85252UOtherBLUE CROSS
TXP00302435OtherRAILROAD MEDICARE
TXP00232623OtherRAILROAD MEDICARE
S28204Medicare UPIN
TX8C6092Medicare ID - Type Unspecified
TX8L11584Medicare PIN