Provider Demographics
NPI:1073822474
Name:GLISS, LINDSAY ASHLEY (MS PNP)
Entity type:Individual
Prefix:MS
First Name:LINDSAY
Middle Name:ASHLEY
Last Name:GLISS
Suffix:
Gender:F
Credentials:MS PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 COLONY ST
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-1708
Mailing Address - Country:US
Mailing Address - Phone:716-684-3974
Mailing Address - Fax:
Practice Address - Street 1:64 COLONY ST
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-1708
Practice Address - Country:US
Practice Address - Phone:716-684-3974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-02
Last Update Date:2010-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382139363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics