Provider Demographics
NPI:1144837618
Name:GLOVER, LISA (CTRS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GLOVER
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1977 RADCLIFF AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-5140
Mailing Address - Country:US
Mailing Address - Phone:616-540-2442
Mailing Address - Fax:
Practice Address - Street 1:1977 RADCLIFF AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-5140
Practice Address - Country:US
Practice Address - Phone:616-540-2442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator