Provider Demographics
NPI:1457353393
Name:GLEZER, CARMEN W (NP)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:W
Last Name:GLEZER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PROFESSIONAL PARK DR
Mailing Address - Street 2:SUITE 21
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6587
Mailing Address - Country:US
Mailing Address - Phone:423-928-5111
Mailing Address - Fax:423-928-1174
Practice Address - Street 1:1 PROFESSIONAL PARK DR
Practice Address - Street 2:SUITE 21
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6587
Practice Address - Country:US
Practice Address - Phone:423-928-5111
Practice Address - Fax:423-928-1174
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN52506363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner