Provider Demographics
NPI:1811304991
Name:BRASS, GLENN L
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:L
Last Name:BRASS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17148 KNOLL DALE TRL
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-1121
Mailing Address - Country:US
Mailing Address - Phone:228-209-3005
Mailing Address - Fax:
Practice Address - Street 1:17148 KNOLL DALE TRL
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-1121
Practice Address - Country:US
Practice Address - Phone:228-209-3005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker