Healthcare Provider Details

I. General information

NPI: 1750650834
Provider Name (Legal Business Name): LINDA S GLOVER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2011
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 N RURAL ST
INDIANAPOLIS IN
46205-2930
US

IV. Provider business mailing address

3838 N RURAL ST
INDIANAPOLIS IN
46205-2930
US

V. Phone/Fax

Practice location:
  • Phone: 317-221-2306
  • Fax: 317-221-2336
Mailing address:
  • Phone: 317-221-2306
  • Fax: 317-221-2336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28051482A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: