Provider Demographics
NPI:1396464582
Name:GLASER, ANGELA NICHOLE (NP)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:NICHOLE
Last Name:GLASER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:NICHOLE
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9404 KENNEBEC RD
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRING
Mailing Address - State:NC
Mailing Address - Zip Code:27592-9413
Mailing Address - Country:US
Mailing Address - Phone:618-420-6040
Mailing Address - Fax:
Practice Address - Street 1:431 N JUDD PKWY NE
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2374
Practice Address - Country:US
Practice Address - Phone:919-552-2292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCGLAS-BU2U5363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily