Healthcare Provider Details

I. General information

NPI: 1013407048
Provider Name (Legal Business Name): BEVERLY GLASGOW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 METRO PL N
DUBLIN OH
43017-5342
US

IV. Provider business mailing address

525 METRO PL N
DUBLIN OH
43017-5342
US

V. Phone/Fax

Practice location:
  • Phone: 614-339-0841
  • Fax:
Mailing address:
  • Phone: 614-339-0841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.151852.MEDS-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: