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General NPI Number Information
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NPI Number | 1134074719
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Entity Type | Individual
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Provider Name | ANGEL GLAZE
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Gender | Female
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Dates
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Enumeration Date | 02/28/2026
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Last Update Date | 02/28/2026
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Provider Practice Location Address
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Address Line | 847 CONNERS CV
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-6934
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Country | US
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Telephone | 404-543-3151
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Fax | 704-582-6112
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Provider Business Mailing Address
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Address Line | 847 CONNERS CV
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-6934
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Country | US
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Telephone | 404-543-3151
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Fax | 704-582-6112
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | CN0030099469
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN215700
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License Number State | GA
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