Healthcare Provider Details

I. General information

NPI: 1457883191
Provider Name (Legal Business Name): DEANA GLASGOW FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 CEDAR POINT BLVD
CEDAR POINT NC
28584-8012
US

IV. Provider business mailing address

718 CEDAR POINT BLVD DEPT 100
CEDAR POINT NC
28584-8012
US

V. Phone/Fax

Practice location:
  • Phone: 252-393-6543
  • Fax: 833-941-2380
Mailing address:
  • Phone: 252-393-6543
  • Fax: 833-941-2380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5009433
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: