Provider Demographics
NPI:1063982429
Name:GLUCK, SHEVA (CNM)
Entity type:Individual
Prefix:MRS
First Name:SHEVA
Middle Name:
Last Name:GLUCK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 FOREST DR.
Mailing Address - Street 2:N/A
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701
Mailing Address - Country:US
Mailing Address - Phone:908-910-3890
Mailing Address - Fax:
Practice Address - Street 1:1382 LANES MILL RD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3833
Practice Address - Country:US
Practice Address - Phone:732-994-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR17868900163W00000X
NJ25ME00067100176B00000X
374J00000X
NJ25ME00067101367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula