Provider Demographics
NPI:1902076672
Name:GLOVER, LAURIE B (FNP, BC)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:B
Last Name:GLOVER
Suffix:
Gender:F
Credentials:FNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 16TH ST S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4713
Mailing Address - Country:US
Mailing Address - Phone:406-761-1309
Mailing Address - Fax:
Practice Address - Street 1:401 15TH AVE S
Practice Address - Street 2:SUITE 106
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4334
Practice Address - Country:US
Practice Address - Phone:406-771-4443
Practice Address - Fax:406-771-4449
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-09
Last Update Date:2008-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTAPRN12606163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice