MEDICARE: WENDY S GLASS PMHNP-BC

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	171M00000X	Case Manager/Care Coordinator		OH
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.0038440	OH

General Provider Information

NPI Number	:	1538970702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY S GLASS PMHNP-BC

Provider Business Mailing Address
First Line	:	3044 COLUMBUS LANCASTER RD NW
Second Line	:
City	:	LANCASTER
State	:	OH
Zip	:	43130-8125
Country	:	US
Telephone Number	:	740-883-9300
Fax Number	:	740-421-3193

Provider Business Practice Location Address
First Line	:	3044 COLUMBUS LANCASTER RD NW
Second Line	:
City	:	LANCASTER
State	:	OH
Zip	:	43130-8125
Country	:	US
Telephone Number	:	740-883-9300
Fax Number	:	740-421-3193

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

Provider Enumeration Date	:	01/16/2025
Last Update Date	:	11/07/2025

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