Provider Demographics
NPI:1144459454
Name:GLASS, MARY LOUISE (LPN)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:LOUISE
Last Name:GLASS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LOUISE
Other - Last Name:GLASS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:3327 TUGEND RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:OH
Mailing Address - Zip Code:44822-9659
Mailing Address - Country:US
Mailing Address - Phone:567-241-9838
Mailing Address - Fax:
Practice Address - Street 1:3327 TUGEND RD
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:OH
Practice Address - Zip Code:44822-9659
Practice Address - Country:US
Practice Address - Phone:567-241-9838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN100045IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse