Provider Demographics
NPI:1932181393
Name:GLASS, DEBRA LYNN (CNM)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LYNN
Last Name:GLASS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23295 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-4206
Mailing Address - Country:US
Mailing Address - Phone:817-366-8817
Mailing Address - Fax:
Practice Address - Street 1:3500 OLD WASHINGTON RD
Practice Address - Street 2:SUITE302
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3224
Practice Address - Country:US
Practice Address - Phone:301-645-8867
Practice Address - Fax:301-645-2330
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR201736367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L6698OtherMEDICARE PTAN