Provider Demographics
NPI:1366200115
Name:GLASS, TENISHA N/A
Entity type:Individual
Prefix:
First Name:TENISHA
Middle Name:N/A
Last Name:GLASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4128 COLUMBIA SQ APT 202
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-2036
Mailing Address - Country:US
Mailing Address - Phone:213-551-1822
Mailing Address - Fax:
Practice Address - Street 1:4128 COLUMBIA SQ APT 202
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-2036
Practice Address - Country:US
Practice Address - Phone:213-551-1822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400078860202376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide