Provider Demographics
NPI:1932225992
Name:GLICK, PATRICIA IRENE (CRNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:IRENE
Last Name:GLICK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:415 ROLLING OAKS DR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1029
Mailing Address - Country:US
Mailing Address - Phone:805-371-4700
Mailing Address - Fax:805-371-4713
Practice Address - Street 1:415 ROLLING OAKS DR
Practice Address - Street 2:SUITE 260
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1029
Practice Address - Country:US
Practice Address - Phone:805-371-4700
Practice Address - Fax:805-371-4713
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP5832363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology