Basic Information
| Provider Information | |||||||||
| NPI: | 1780614388 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GLASGOW | ||||||||
| FirstName: | JEFFERY | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 WAKARUSA DR STE A3 | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660493889 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858566170 | ||||||||
| FaxNumber: | 7858566171 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 WAKARUSA DR | ||||||||
| Address2: | BLDG A SUIT 3 | ||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660494722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858566170 | ||||||||
| FaxNumber: | 7858566171 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 10/17/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 55036 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.