Individual
LAWANDA GLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
714 3RD ST, CLEVELAND, MS 38732
(662) 846-2620
(662) 846-2660
Mailing address
PO BOX 1505, GREENWOOD, MS 38935-1505
(662) 453-6211
(662) 458-2558
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
902444
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
330000014
—
AL
Enumeration date
10/18/2017
Last updated
07/16/2018
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