Provider Demographics
NPI:1811245335
Name:GLOVER, MARK (RN)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:GLOVER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 N LUCY MONTGOMERY WAY
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-6707
Mailing Address - Country:US
Mailing Address - Phone:913-387-9581
Mailing Address - Fax:
Practice Address - Street 1:11630 W 80TH ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66214-3340
Practice Address - Country:US
Practice Address - Phone:913-752-2148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC196632163WI0500X, 163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy