Basic Information
| Provider Information | |||||||||
| NPI: | 1366449530 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLOW | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 32 CAMPUS DR | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598120003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062432536 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2831 FORT MISSOULA RD | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598047419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067284100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN26731 | MT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.