Provider Demographics
NPI:1386128395
Name:GLASGOW, CYNTHIA LOU
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LOU
Last Name:GLASGOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 STAUNTON AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1538
Mailing Address - Country:US
Mailing Address - Phone:814-771-1115
Mailing Address - Fax:
Practice Address - Street 1:3808 STAUNTON AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1538
Practice Address - Country:US
Practice Address - Phone:814-771-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN250764L164W00000X
MDLP54125164W00000X
WV35119164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse