Individual
JACI R GLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6890 COLLISI PL, BROWNSBURG, IN 46112-9134
(317) 835-1370
Mailing address
6890 COLLISI PL, BROWNSBURG, IN 46112-9134
(317) 835-1370
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
28174021A
IN
363LA2200X
Adult Health Nurse Practitioner
Primary
71003660A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201035270
—
IN
Enumeration date
09/13/2011
Last updated
09/11/2024
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