Individual
HEATHER GLOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
325 ESSJAY RD STE 170, WILLIAMSVILLE, NY 14221-8243
(716) 631-2517
Mailing address
325 ESSJAY RD, WILLIAMSVILLE, NY 14221-8243
(716) 631-2517
(716) 634-5650
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
017985
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017985
LICENSE
NY
Enumeration date
09/17/2014
Last updated
02/13/2019
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