Provider Demographics
NPI:1871264531
Name:GLASS, ELISABETH J
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:J
Last Name:GLASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18855 YOUNG RD
Mailing Address - Street 2:
Mailing Address - City:GUYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45735-9651
Mailing Address - Country:US
Mailing Address - Phone:740-517-2413
Mailing Address - Fax:
Practice Address - Street 1:18855 YOUNG RD
Practice Address - Street 2:
Practice Address - City:GUYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:45735-9651
Practice Address - Country:US
Practice Address - Phone:740-517-2413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker