MEDICARE: EMILY GLASER BSN, 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	163W00000X	Registered Nurse	#R66349	NM
2	163WM1400X	Nurse Massage Therapist (NMT)	8136	NM

General Provider Information

NPI Number	:	1750670709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY GLASER BSN, LMT

Provider Business Mailing Address
First Line	:	6 SIERRA LAVANDA
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-0108
Country	:	US
Telephone Number	:	505-699-6018
Fax Number	:

Provider Business Practice Location Address
First Line	:	1622 SAINT MICHAELS DR
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-7712
Country	:	US
Telephone Number	:	505-699-6018
Fax Number	:

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

Provider Enumeration Date	:	03/30/2011
Last Update Date	:	04/07/2016

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