Healthcare Provider Details

I. General information

NPI: 1861704702
Provider Name (Legal Business Name): JANINE LOUISE GLOVER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 E 3RD ST SUITE 215
CASPER WY
82601-3237
US

IV. Provider business mailing address

940 E 3RD ST SUITE 215
CASPER WY
82601-3237
US

V. Phone/Fax

Practice location:
  • Phone: 307-337-4981
  • Fax: 307-337-4984
Mailing address:
  • Phone: 307-337-4981
  • Fax: 307-337-4984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number16879
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number16879.1233
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: