Provider Demographics
NPI:1114817822
Name:INNERGLOW HEALTH
Entity type:Organization
Organization Name:INNERGLOW HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-292-7676
Mailing Address - Street 1:2043 19TH AVENUE CIR NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-0577
Mailing Address - Country:US
Mailing Address - Phone:828-292-7679
Mailing Address - Fax:
Practice Address - Street 1:2043 19TH AVENUE CIR NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-0577
Practice Address - Country:US
Practice Address - Phone:828-292-7676
Practice Address - Fax:828-292-7679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-04
Last Update Date:2025-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty