MEDICARE: CARMEN W GLEZER NP

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	363L00000X	Nurse Practitioner	52506	TN

General Provider Information

NPI Number	:	1457353393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN W GLEZER NP

Provider Business Mailing Address
First Line	:	1 PROFESSIONAL PARK DR
Second Line	:	SUITE 21
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-6587
Country	:	US
Telephone Number	:	423-928-5111
Fax Number	:	423-928-1174

Provider Business Practice Location Address
First Line	:	1 PROFESSIONAL PARK DR
Second Line	:	SUITE 21
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-6587
Country	:	US
Telephone Number	:	423-928-5111
Fax Number	:	423-928-1174

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/08/2007

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Directions to “ CARMEN W GLEZER NP” Practice Location

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