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General NPI Number Information
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NPI Number | 1235680398
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Entity Type | Individual
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Provider Name | SHARLEEN GLASS NP
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Gender | Female
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Dates
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Enumeration Date | 10/24/2016
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 2936 N ELM ST STE 102
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City | LUMBERTON
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State | NC
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Zip | 28358-2981
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Country | US
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Telephone | 910-671-6619
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Fax |
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Provider Business Mailing Address
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Address Line | 15940 LOVEGRASS LN
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City | WAGRAM
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State | NC
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Zip | 28396-6000
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Country | US
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Telephone | 904-403-0960
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Fax |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 256300
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 5009110
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License Number State | NC
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