Provider Demographics
NPI:1194564518
Name:GLOVER, LEARY (RN)
Entity type:Individual
Prefix:
First Name:LEARY
Middle Name:
Last Name:GLOVER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LEARY
Other - Middle Name:
Other - Last Name:GLOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3031 WEDDINGTON POINTE DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-9844
Mailing Address - Country:US
Mailing Address - Phone:516-770-7033
Mailing Address - Fax:
Practice Address - Street 1:3031 WEDDINGTON POINTE DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-9844
Practice Address - Country:US
Practice Address - Phone:516-770-7033
Practice Address - Fax:631-995-6711
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC320095163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice