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General NPI Number Information
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NPI Number | 1710176912
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Entity Type | Organization
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Legal Business Name | INFORMED CARE SOLUTION, INC
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 10/24/2007
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Provider Practice Location Address
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Address Line | 325 FOUR LEAF LN SUITE 11
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-9203
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Country | US
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Telephone | 772-344-3702
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Fax | 772-344-3701
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Provider Business Mailing Address
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Address Line | PO BOX 6250
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22906-6250
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Country | US
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Telephone | 772-344-3702
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Fax | 772-344-3701
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | SANDI GLASER
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Credential |
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Telephone | 772-344-3702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP0024165998
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0017001266
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License Number State | VA
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