Provider Demographics
NPI:1962012963
Name:GLASCO, BRANDI WILLENE
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:WILLENE
Last Name:GLASCO
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 1:3500 SILVER PARK DR APT 4
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-2903
Mailing Address - Country:US
Mailing Address - Phone:202-820-0168
Mailing Address - Fax:
Practice Address - Street 1:2515 ALABAMA AVE SE APT 203
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3231
Practice Address - Country:US
Practice Address - Phone:202-820-0168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant