Provider Demographics
NPI:1235485525
Name:GLANTZ, KIM (RN)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:
Last Name:GLANTZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-2216
Mailing Address - Country:US
Mailing Address - Phone:315-225-7047
Mailing Address - Fax:
Practice Address - Street 1:409 BELL RD S
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-3864
Practice Address - Country:US
Practice Address - Phone:315-338-6532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY354764-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool