MEDICARE: BERNADETTE A GLASSER FNP

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	363LF0000X	Family Nurse Practitioner	APN11736	TN
2	363LF0000X	Family Nurse Practitioner	105874	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4121218	OTHER	TN	BLUE CROSS BLUE SHIELD TN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871504589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNADETTE A GLASSER FNP

Provider Business Mailing Address
First Line	:	3800 EASTSIDE HWY
Second Line	:
City	:	STEVENSVILLE
State	:	MT
Zip	:	59870-2224
Country	:	US
Telephone Number	:	406-777-2775
Fax Number	:	406-777-2796

Provider Business Practice Location Address
First Line	:	3800 EASTSIDE HWY
Second Line	:
City	:	STEVENSVILLE
State	:	MT
Zip	:	59870-2224
Country	:	US
Telephone Number	:	406-777-2775
Fax Number	:	406-777-2796

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	02/01/2017

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