Individual
LISA ROBIN GLASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
13370 E MARY ANN CLEVELAND WAY STE 102, VAIL, AZ 85641-8610
(520) 585-5002
(520) 585-5008
Mailing address
85 FAIRFIELD WAY APT 9, COMMACK, NY 11725-3426
(631) 651-8922
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
344218
NY
Other
Enumeration date
03/12/2019
Last updated
08/04/2022
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