Provider Demographics
NPI:1154522654
Name:GLASS, SANDRA L (RN)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:GLASS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 SOMERS AVE
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-8517
Mailing Address - Country:US
Mailing Address - Phone:609-926-1006
Mailing Address - Fax:
Practice Address - Street 1:13 SOMERS AVE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-8517
Practice Address - Country:US
Practice Address - Phone:609-926-1006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR12667200163W00000X, 163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine