Provider Demographics
NPI:1285979682
Name:GLOVER, AUDREY (FNP-BC)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:GLOVER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 LIMESTONE DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7051
Mailing Address - Country:US
Mailing Address - Phone:716-626-4200
Mailing Address - Fax:716-626-4201
Practice Address - Street 1:9 LIMESTONE DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-626-4200
Practice Address - Fax:716-626-4201
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2019-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily