Individual
KELSEY MARIE GLIDEWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
400 N PEPPER AVE, COLTON, CA 92324-1801
(909) 580-6170
Mailing address
PHR GROUP PROVIDER ENROLLMENT UNIT, 393 E WALNUT ST FL 3, PASADENA, CA 91188-0001
(877) 608-0044
(877) 514-0903
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
54919
CA
Other
Enumeration date
09/24/2017
Last updated
12/08/2021
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