Healthcare Provider Details

I. General information

NPI: 1306136742
Provider Name (Legal Business Name): DAWN MARIE GLASS ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAWN MARIE ARAPAKOS

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 PRINCETON RD SUITE 101
JOHNSON CITY TN
37601-2049
US

IV. Provider business mailing address

119 BOONE RIDGE DR STE 201
JOHNSON CITY TN
37615-8000
US

V. Phone/Fax

Practice location:
  • Phone: 423-282-1171
  • Fax: 423-282-1181
Mailing address:
  • Phone: 423-282-1171
  • Fax: 423-282-1181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN15781
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: