Healthcare Provider Details

I. General information

NPI: 1235680398
Provider Name (Legal Business Name): SHARLEEN GLASS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2936 N ELM ST STE 102
LUMBERTON NC
28358-2981
US

IV. Provider business mailing address

15940 LOVEGRASS LN
WAGRAM NC
28396-6000
US

V. Phone/Fax

Practice location:
  • Phone: 910-671-6619
  • Fax:
Mailing address:
  • Phone: 904-403-0960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number256300
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5009110
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: