Healthcare Provider Details

I. General information

NPI: 1871233445
Provider Name (Legal Business Name): KYLI GLASER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 ORRS LN
TRIADELPHIA WV
26059-1455
US

IV. Provider business mailing address

40 ORRS LN
TRIADELPHIA WV
26059-1455
US

V. Phone/Fax

Practice location:
  • Phone: 304-559-2146
  • Fax:
Mailing address:
  • Phone: 304-559-2146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number38055
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: