Provider Demographics
NPI:1184757767
Name:GLOVER, JUDY (RN)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:
Last Name:GLOVER
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 1:17613 N 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-2504
Mailing Address - Country:US
Mailing Address - Phone:602-942-7527
Mailing Address - Fax:
Practice Address - Street 1:19602 N 45TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7339
Practice Address - Country:US
Practice Address - Phone:623-445-4310
Practice Address - Fax:623-445-4380
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN048975163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ974114Medicare ID - Type Unspecified