Provider Demographics
NPI:1750321246
Name:GLAVIN, SONYA MORIN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:MORIN
Last Name:GLAVIN
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 1:1005 HAMLET PARK DR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6643
Mailing Address - Country:US
Mailing Address - Phone:919-371-1467
Mailing Address - Fax:
Practice Address - Street 1:6020 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-9754
Practice Address - Country:US
Practice Address - Phone:919-572-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201069363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2598228Medicare PIN
NCS61606Medicare UPIN
NC2598228BMedicare PIN