Provider Demographics
NPI:1679674808
Name:GLICK, MARCIA J (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:J
Last Name:GLICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 61 BOX 390
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:88039-9600
Mailing Address - Country:US
Mailing Address - Phone:505-539-2576
Mailing Address - Fax:505-533-6767
Practice Address - Street 1:1 FOSTER LANE
Practice Address - Street 2:
Practice Address - City:RESERVE
Practice Address - State:NM
Practice Address - Zip Code:87830
Practice Address - Country:US
Practice Address - Phone:505-533-6456
Practice Address - Fax:505-533-6767
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR41730163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse