Provider Demographics
NPI:1942688163
Name:GLASPER, JANET
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:GLASPER
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 1:2208 MADERO DR
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62221-3186
Mailing Address - Country:US
Mailing Address - Phone:618-570-7558
Mailing Address - Fax:618-257-0112
Practice Address - Street 1:2208 MADERO DR
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62221-3186
Practice Address - Country:US
Practice Address - Phone:618-570-7558
Practice Address - Fax:618-257-0112
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL472652195001Medicaid