=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619261138
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE CALIO GLYNN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2011
-----------------------------------------------------
Last Update Date | 11/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 DANIEL BURNHAM CT STE 370C
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94109-0470
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-991-4690
-----------------------------------------------------
Fax | 415-732-7030
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 32071
-----------------------------------------------------
City | BELFAST
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04915-0197
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-991-4690
-----------------------------------------------------
Fax | 415-732-7030
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | A116076
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------