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General NPI Number Information
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NPI Number | 1679674808
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Entity Type | Individual
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Provider Name | MARCIA J. GLICK R.N.
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Gender | Female
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 FOSTER LANE
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City | RESERVE
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State | NM
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Zip | 87830
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Country | US
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Telephone | 505-533-6456
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Fax | 505-533-6767
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Provider Business Mailing Address
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Address Line | HC 61 BOX 390
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City | GLENWOOD
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State | NM
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Zip | 88039-9600
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Country | US
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Telephone | 505-539-2576
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Fax | 505-533-6767
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R41730
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License Number State | NM
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