Provider Demographics
NPI:1871512103
Name:GLANCY, LEA A (NP)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:A
Last Name:GLANCY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:A
Other - Last Name:ALVERNAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1801 N. SENATE BLVD MPC2 #3300
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1228
Practice Address - Country:US
Practice Address - Phone:317-923-1787
Practice Address - Fax:317-962-0262
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002021363L00000X
IN71002021A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01027330OtherRAILROAD MEDICARE
IN201014890Medicaid
INM400039296Medicare PIN
INP01216513Medicare PIN