Provider Demographics
NPI:1821659251
Name:GLASS, ROBBIN LYNN
Entity Type:Individual
Prefix:
First Name:ROBBIN
Middle Name:LYNN
Last Name:GLASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6336 S M 66 HWY
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49073-9507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6336 S M 66 HWY
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:MI
Practice Address - Zip Code:49073-9507
Practice Address - Country:US
Practice Address - Phone:616-427-8568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704168534163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse