MEDICARE: TENISHA N/A GLASS

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	376K00000X	Nurse's Aide	400078860202	OH

General Provider Information

NPI Number	:	1366200115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TENISHA N/A GLASS

Provider Business Mailing Address
First Line	:	4128 COLUMBIA SQ APT 202
Second Line	:
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070-2036
Country	:	US
Telephone Number	:	213-551-1822
Fax Number	:

Provider Business Practice Location Address
First Line	:	4128 COLUMBIA SQ APT 202
Second Line	:
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070-2036
Country	:	US
Telephone Number	:	213-551-1822
Fax Number	:

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

Provider Enumeration Date	:	03/07/2024
Last Update Date	:	03/07/2024

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Directions to “ TENISHA N/A GLASS ” Practice Location

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