MEDICARE: NICOLE EVETTE GLESINGER LMT

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	174400000X	Specialist	MT-16989	AZ

General Provider Information

NPI Number	:	1639516644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE EVETTE GLESINGER LMT

Provider Business Mailing Address
First Line	:	2748 N PACIFIC DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-4283
Country	:	US
Telephone Number	:	520-247-3362
Fax Number	:	520-623-7064

Provider Business Practice Location Address
First Line	:	2571 N 1ST AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-2910
Country	:	US
Telephone Number	:	520-247-3362
Fax Number	:	520-623-7064

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

Provider Enumeration Date	:	05/30/2013
Last Update Date	:	05/30/2013

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