Provider Demographics
NPI:1952645095
Name:GLAZKOVA, NATALIYA (RN)
Entity Type:Individual
Prefix:
First Name:NATALIYA
Middle Name:
Last Name:GLAZKOVA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 HOOPER ST
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3719
Mailing Address - Country:US
Mailing Address - Phone:646-270-9165
Mailing Address - Fax:347-710-1002
Practice Address - Street 1:73 HOOPER ST APT A6
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3719
Practice Address - Country:US
Practice Address - Phone:646-270-9165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY647211163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health