Provider Demographics
NPI:1134250996
Name:GLASCO, KRISTINA R (RNMS CS-P)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:R
Last Name:GLASCO
Suffix:
Gender:F
Credentials:RNMS CS-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 RIVERSIDE RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-1506
Mailing Address - Country:US
Mailing Address - Phone:301-585-8861
Mailing Address - Fax:301-585-3868
Practice Address - Street 1:9525 COLESVILLE RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4843
Practice Address - Country:US
Practice Address - Phone:301-585-8861
Practice Address - Fax:301-585-3868
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC000257163WP0809X
VA0001197850163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD369SMedicare ID - Type Unspecified