Provider Demographics
NPI:1639357379
Name:MCGLOTHLIN, ELIZABETH P (NP)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:P
Last Name:MCGLOTHLIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:338 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-3500
Mailing Address - Country:US
Mailing Address - Phone:812-349-7343
Mailing Address - Fax:812-349-7346
Practice Address - Street 1:338 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-3500
Practice Address - Country:US
Practice Address - Phone:812-349-7343
Practice Address - Fax:812-349-7346
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001312A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily