Provider Demographics
NPI:1851601744
Name:GLANVILLE, LINDSAY NICOLE (PA)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:NICOLE
Last Name:GLANVILLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:NICOLE
Other - Last Name:DRISCOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2440 RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4145
Mailing Address - Country:US
Mailing Address - Phone:585-720-1550
Mailing Address - Fax:585-720-1553
Practice Address - Street 1:2440 RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4145
Practice Address - Country:US
Practice Address - Phone:585-720-1550
Practice Address - Fax:585-720-1553
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014350363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400032268/GP 70008AMedicare PIN
NYJ400032267/GP BA0017Medicare PIN