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General NPI Number Information
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NPI Number | 1730615790
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Entity Type | Individual
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Provider Name | PETRA S GLOVER NP-C
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Gender | Female
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 2300 MANCHESTER EXPY STE 1003
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City | COLUMBUS
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State | GA
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Zip | 31904-6802
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Country | US
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Telephone | 706-565-7382
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Fax | 706-565-9110
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Provider Business Mailing Address
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Address Line | PO BOX 7335
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City | COLUMBUS
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State | GA
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Zip | 31908-7335
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Country | US
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Telephone | 706-320-3128
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Fax | 706-320-3230
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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 | RN150430
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License Number State | GA
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