Provider Demographics
NPI:1780967257
Name:GLOMSET, ERIN BELANGER (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:BELANGER
Last Name:GLOMSET
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 SW 79TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6427
Mailing Address - Country:US
Mailing Address - Phone:985-860-2642
Mailing Address - Fax:
Practice Address - Street 1:5606 SW LEE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9651
Practice Address - Country:US
Practice Address - Phone:580-699-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2165363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2165046Medicaid
OK57627PF44Medicare PIN