MEDICARE: GLAZEN KAITLYN CELERIO RN

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	743136	NY

General Provider Information

NPI Number	:	1760058630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLAZEN KAITLYN CELERIO RN

Provider Business Mailing Address
First Line	:	3636 10TH ST
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-5112
Country	:	US
Telephone Number	:	646-906-1069
Fax Number	:

Provider Business Practice Location Address
First Line	:	3636 10TH ST
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-5112
Country	:	US
Telephone Number	:	646-906-1069
Fax Number	:

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

Provider Enumeration Date	:	06/01/2021
Last Update Date	:	10/08/2024

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