Provider Demographics
NPI:1427732791
Name:GLAZE, ERICA (IBCLC)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:GLAZE
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 S KYRENE RD STE 125
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-2172
Mailing Address - Country:US
Mailing Address - Phone:480-442-8491
Mailing Address - Fax:
Practice Address - Street 1:8400 S KYRENE RD STE 125
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-2172
Practice Address - Country:US
Practice Address - Phone:480-442-8491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN