Provider Demographics
NPI:1245370964
Name:GLISPIE, VERNEAL YVONNE (CNP, MSN)
Entity type:Individual
Prefix:MS
First Name:VERNEAL
Middle Name:YVONNE
Last Name:GLISPIE
Suffix:
Gender:F
Credentials:CNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33030 VAN BORN RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-2453
Mailing Address - Country:US
Mailing Address - Phone:734-727-7172
Mailing Address - Fax:
Practice Address - Street 1:33030 VAN BORN RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-2453
Practice Address - Country:US
Practice Address - Phone:734-727-7172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704133129363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4924510Medicare ID - Type Unspecified