Provider Demographics
NPI:1992256770
Name:GLAZEBROOK, MARJANE (RN)
Entity type:Individual
Prefix:
First Name:MARJANE
Middle Name:
Last Name:GLAZEBROOK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 DESIGNERS CT
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-8702
Mailing Address - Country:US
Mailing Address - Phone:505-271-3068
Mailing Address - Fax:505-291-5456
Practice Address - Street 1:801 STEPHEN MOODY ST SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-1994
Practice Address - Country:US
Practice Address - Phone:505-271-3068
Practice Address - Fax:505-291-5456
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR21457163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool