Healthcare Provider Details

I. General information

NPI: 1184693921
Provider Name (Legal Business Name): MARY ELIZABETH GLAESER RNCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 18TH ST E
HASTINGS MN
55033-3680
US

IV. Provider business mailing address

1200 18TH ST E
HASTINGS MN
55033
US

V. Phone/Fax

Practice location:
  • Phone: 651-438-8500
  • Fax:
Mailing address:
  • Phone: 651-438-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR0863629
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0863629
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: