Provider Demographics
NPI:1780614388
Name:GLASGOW, JEFFERY WILLIAM (CRNA)
Entity type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:WILLIAM
Last Name:GLASGOW
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:1201 WAKARUSA DR STE A3
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3889
Mailing Address - Country:US
Mailing Address - Phone:785-856-6170
Mailing Address - Fax:785-856-6171
Practice Address - Street 1:1201 WAKARUSA DR
Practice Address - Street 2:BLDG A SUIT 3
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4722
Practice Address - Country:US
Practice Address - Phone:785-856-6170
Practice Address - Fax:785-856-6171
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS55036367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered