Provider Demographics
NPI:1548887540
Name:GLASCO, VENICE LYNELL
Entity type:Individual
Prefix:
First Name:VENICE
Middle Name:LYNELL
Last Name:GLASCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3718 GRANT PL NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-1870
Mailing Address - Country:US
Mailing Address - Phone:202-246-0990
Mailing Address - Fax:
Practice Address - Street 1:2515 ALABAMA AVE SE APT 203
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3231
Practice Address - Country:US
Practice Address - Phone:202-246-0990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant