Provider Demographics
NPI:1407209323
Name:GLOVER, SURENA
Entity type:Individual
Prefix:MS
First Name:SURENA
Middle Name:
Last Name:GLOVER
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 1:410 HUSTINGS LN
Mailing Address - Street 2:UNIT E
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-2807
Mailing Address - Country:US
Mailing Address - Phone:757-419-3941
Mailing Address - Fax:757-325-8283
Practice Address - Street 1:410 HUSTINGS LN
Practice Address - Street 2:UNIT E
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-2807
Practice Address - Country:US
Practice Address - Phone:757-419-3941
Practice Address - Fax:757-325-8283
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)