Healthcare Provider Details

I. General information

NPI: 1750670709
Provider Name (Legal Business Name): EMILY GLASER BSN, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 SAINT MICHAELS DR
SANTA FE NM
87505-7712
US

IV. Provider business mailing address

6 SIERRA LAVANDA
SANTA FE NM
87507-0108
US

V. Phone/Fax

Practice location:
  • Phone: 505-699-6018
  • Fax:
Mailing address:
  • Phone: 505-699-6018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number#R66349
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License Number8136
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: