Provider Demographics
NPI:1104923416
Name:GLASSROTH, CAROL HOLTON (RN, MSN, APN)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:HOLTON
Last Name:GLASSROTH
Suffix:
Gender:F
Credentials:RN, MSN, APN
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:GLASSROTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, MSN, APN
Mailing Address - Street 1:366 TAPPAN ST. #4
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-0244
Mailing Address - Country:US
Mailing Address - Phone:617-879-0890
Mailing Address - Fax:
Practice Address - Street 1:BRIGHAM AND WOMEN'S HOSPITAL
Practice Address - Street 2:75 FRANCIS ST
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-378-5485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA140142363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health