Individual
MS. GLORIA VON ROSSUM LIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CPNP
Contact information
Practice address
4500 STUART ST, MONCRIEF ARMY HOSPITAL, ATTN: MCXL-PQ (CREDENTIALS), COLUMBIA, SC 29207-5700
(803) 751-2689
Mailing address
4500 STUART ST, MONCRIEF ARMY HOSPITAL, ATTN: MCXL-PQ (CREDENTIALS), COLUMBIA, SC 29207-5700
(803) 751-2689
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
243250
TX
Other
Enumeration date
09/15/2006
Last updated
07/08/2007
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