Healthcare Provider Details

I. General information

NPI: 1487921177
Provider Name (Legal Business Name): DENISE JACOBSON GLOVER RN, MSN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 BRUCEVILLE RD
SACRAMENTO CA
95823-4671
US

IV. Provider business mailing address

6600 BRUCEVILLE RD
SACRAMENTO CA
95823-4671
US

V. Phone/Fax

Practice location:
  • Phone: 916-247-6486
  • Fax:
Mailing address:
  • Phone: 916-247-6486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number463233
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number3581
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: