MEDICARE: MS. LAUREN GLASSEY FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1744R1102X	Research Study Specialist	RN129818	AZ
2	363LF0000X	Family Nurse Practitioner	AP3589	AZ

General Provider Information

NPI Number	:	1134346752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAUREN GLASSEY FNP

Provider Business Mailing Address
First Line	:	3003 N CENTRAL AVE
Second Line	:	SUITE 800
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2902
Country	:	US
Telephone Number	:	520-465-6394
Fax Number	:

Provider Business Practice Location Address
First Line	:	3003 N CENTRAL AVE
Second Line	:	SUITE 800
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2902
Country	:	US
Telephone Number	:	520-465-6394
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	05/13/2014

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