Basic Information
Provider Information
NPI: 1023544079
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GLOVER
FirstName: BRITNEY
MiddleName: MARIE
NamePrefix: MRS.
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1100 REID PARKWAY
Address2: MEDICAL STAFF SERVICES
City: RICHMOND
State: IN
PostalCode: 47374
CountryCode: US
TelephoneNumber: 7659833127
FaxNumber: 7659833219
Practice Location
Address1: 1485 CHESTER BLVD.
Address2: REID PEDIATRIC & INTERNAL MEDICINE
City: RICHMOND
State: IN
PostalCode: 473741919
CountryCode: US
TelephoneNumber: 7659665527
FaxNumber: 7659665528
Other Information
ProviderEnumerationDate: 05/11/2017
LastUpdateDate: 05/25/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/14/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X71007044AINY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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