Individual
SUSAN KAY GLASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2789 ORTIZ AVE, FORT MYERS, FL 33905-7806
(239) 275-3222
Mailing address
2789 ORTIZ AVE, FORT MYERS, FL 33905-7806
(239) 275-3222
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5195391
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PN5195391
LPN LICENSE
FL
Enumeration date
07/10/2012
Last updated
07/10/2012
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