Healthcare Provider Details

I. General information

NPI: 1821661547
Provider Name (Legal Business Name): NIKKI J GLASS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 KUMHO DR STE 101
FAIRLAWN OH
44333-9298
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 330-576-0126
  • Fax: 216-649-0551
Mailing address:
  • Phone: 216-468-5000
  • Fax: 216-456-8128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0029590
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: