Individual
FAE M GLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
222 N 7TH ST, BISMARCK, ND 58501-4436
(701) 323-6000
(701) 323-5369
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
(605) 328-6585
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
R28630
ND
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R28630
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19871
—
ND
Enumeration date
07/10/2007
Last updated
04/06/2023
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