Healthcare Provider Details

I. General information

NPI: 1497088496
Provider Name (Legal Business Name): HEATHER L GLASMAN BMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LETTON DR
RATON NM
87740-4366
US

IV. Provider business mailing address

PO BOX 803
SPRINGER NM
87747-0803
US

V. Phone/Fax

Practice location:
  • Phone: 575-445-8568
  • Fax: 575-445-0540
Mailing address:
  • Phone: 575-643-9908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: