Provider Demographics
NPI:1699734566
Name:GLASGOW, JANE ZENAIDA (LPN)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:ZENAIDA
Last Name:GLASGOW
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 BAXTER AVE
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-1240
Mailing Address - Country:US
Mailing Address - Phone:715-394-4087
Mailing Address - Fax:
Practice Address - Street 1:29250 COUNTY HWY E
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:WI
Practice Address - Zip Code:54856-1072
Practice Address - Country:US
Practice Address - Phone:715-765-4791
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38320100Medicaid