Provider Demographics
NPI:1790780898
Name:GLAZIER, JENNIFER ANN (CS M-S CNS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:GLAZIER
Suffix:
Gender:F
Credentials:CS M-S CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19550 E 39TH ST S
Mailing Address - Street 2:SUITE 220
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2358
Mailing Address - Country:US
Mailing Address - Phone:816-461-6837
Mailing Address - Fax:816-833-1760
Practice Address - Street 1:19550 E 39TH ST S
Practice Address - Street 2:SUITE 220
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2358
Practice Address - Country:US
Practice Address - Phone:816-461-6837
Practice Address - Fax:816-833-1760
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO118113364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO428786602Medicaid
MOP01873Medicare UPIN
MOJ38A217Medicare ID - Type Unspecified