Individual
LISA G GLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 S BLISS AVE, TAHLEQUAH, OK 74464-2512
(918) 458-3100
Mailing address
408 PATTI CIR, TAHLEQUAH, OK 74464-4021
(918) 458-3100
(918) 458-3511
Taxonomy
Speciality
Code
Description
License number
State
246W00000X
Cardiology Technician
—
—
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
Primary
—
—
Other
Enumeration date
10/04/2006
Last updated
09/11/2025
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