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Individual

LAURA E GLASS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNP

Contact information

Practice address
105 US HIGHWAY 80 E, DEMOPOLIS, AL 36732-3605
(334) 289-4000
Mailing address
105 US HIGHWAY 80 E, DEMOPOLIS, AL 36732-3605
(334) 287-2423

Taxonomy

Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
1-144028
AL
363LP2300X
Primary Care Nurse Practitioner
Primary
1-144028
AL

Other

Enumeration date
08/15/2019
Last updated
08/15/2019
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