Provider Demographics
NPI:1902240369
Name:GLASU-ATUNUWA, ELSIE ENYONAM (RN)
Entity type:Individual
Prefix:MISS
First Name:ELSIE
Middle Name:ENYONAM
Last Name:GLASU-ATUNUWA
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:ENYONAM
Other - Middle Name:ELSIE
Other - Last Name:GLASU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9114 HIGHLAND STAR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-4603
Mailing Address - Country:US
Mailing Address - Phone:516-225-3625
Mailing Address - Fax:
Practice Address - Street 1:10717 170TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-2408
Practice Address - Country:US
Practice Address - Phone:516-225-3625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX883777171M00000X
NY655909163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator