Provider Demographics
NPI:1861704702
Name:GLOVER, JANINE LOUISE (NP-C)
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:LOUISE
Last Name:GLOVER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 E 3RD ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3237
Mailing Address - Country:US
Mailing Address - Phone:307-337-4981
Mailing Address - Fax:307-337-4984
Practice Address - Street 1:940 E 3RD ST
Practice Address - Street 2:SUITE 215
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3237
Practice Address - Country:US
Practice Address - Phone:307-337-4981
Practice Address - Fax:307-337-4984
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY16879163WR0006X
WY16879.1233363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant