Provider Demographics
NPI:1942765094
Name:BOADO, GLAIZA MICU (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:GLAIZA
Middle Name:MICU
Last Name:BOADO
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 RIVERWAY BLUFF LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-2170
Mailing Address - Country:US
Mailing Address - Phone:832-499-4445
Mailing Address - Fax:
Practice Address - Street 1:211 RIVERWAY BLUFF LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-2170
Practice Address - Country:US
Practice Address - Phone:832-499-4445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139677363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care