Individual
LISA G GLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
3015 WILSON AVE, LOUISVILLE, KY 40211-1969
(502) 774-4401
(502) 772-4783
Mailing address
3015 WILSON AVE, LOUISVILLE, KY 40211-1969
(502) 774-4401
(502) 772-4783
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
3002970
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000066843
BLUE ACCESS/BLUE PREF.
—
01
—
61-1708562D
HUMANA
—
01
—
7719001
AETNA
—
05
—
78029709
—
KY
Enumeration date
08/02/2005
Last updated
02/13/2023
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