Provider Demographics
NPI:1750670709
Name:GLASER, EMILY (BSN, LMT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GLASER
Suffix:
Gender:F
Credentials:BSN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SIERRA LAVANDA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-0108
Mailing Address - Country:US
Mailing Address - Phone:505-699-6018
Mailing Address - Fax:
Practice Address - Street 1:1622 SAINT MICHAELS DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7712
Practice Address - Country:US
Practice Address - Phone:505-699-6018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM#R66349163W00000X
NM8136163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)