MEDICARE: MRS. ELIZABETH ANN GLASS LPN

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	164W00000X	Licensed Practical Nurse	PN.118007	OH

General Provider Information

NPI Number	:	1164664736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH ANN GLASS LPN

Provider Business Mailing Address
First Line	:	14 ARBOR CIR
Second Line	:	APT 1425
City	:	CINCINNATI
State	:	OH
Zip	:	45255-5811
Country	:	US
Telephone Number	:	513-843-4308
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 ARBOR CIR
Second Line	:	APT 1425
City	:	CINCINNATI
State	:	OH
Zip	:	45255-5811
Country	:	US
Telephone Number	:	513-843-4308
Fax Number	:

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

Provider Enumeration Date	:	03/29/2009
Last Update Date	:	03/29/2009

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