Provider Demographics
NPI:1952522294
Name:GLASS, ERICA DENISE (NA2)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:DENISE
Last Name:GLASS
Suffix:
Gender:F
Credentials:NA2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 E G ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-3223
Mailing Address - Country:US
Mailing Address - Phone:423-543-2521
Mailing Address - Fax:423-543-7348
Practice Address - Street 1:403 E G ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-3223
Practice Address - Country:US
Practice Address - Phone:423-543-2521
Practice Address - Fax:423-543-7348
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN88120376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide