Provider Demographics
NPI:1962727511
Name:GLOVER, CAROLINE P (LPN)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:P
Last Name:GLOVER
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 1:415 E MOUND ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-5512
Mailing Address - Country:US
Mailing Address - Phone:614-849-0550
Mailing Address - Fax:614-849-0060
Practice Address - Street 1:415 E MOUND ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5512
Practice Address - Country:US
Practice Address - Phone:614-849-0550
Practice Address - Fax:614-849-0060
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 108359164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2358274Medicaid