Healthcare Provider Details

I. General information

NPI: 1568583250
Provider Name (Legal Business Name): LOIS IRENE GLANVILLE PHD, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210-E MARY GLADWIN HALL
AKRON OH
44325-3703
US

IV. Provider business mailing address

1835 CALVERT DR
CUYAHOGA FALLS OH
44223-1020
US

V. Phone/Fax

Practice location:
  • Phone: 330-972-7733
  • Fax: 330-972-5737
Mailing address:
  • Phone: 330-929-4963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA NP-0570 RN-11744
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: