| Doctor Name: | HEATHER GLOSE |
| NPI Number: | 1023410461 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 017985 |
| Business Practice Address: | 3805 Lockport Olcott Rd Lockport, NY - 140941128 |
| Business Phone Number: | 7164394248 |
| Business Fax Number: | 7164394838 |
| Mailing Address: | 3805 Lockport Olcott Rd, LOCKPORT |
| State: | NY |
| Postal Code: | 140941128 |
| Phone Number: | 7164394248 |
| Fax Number: | 7164394838 |
| NPI Enumeration Date: | 09/17/2014 |
| NPI Last Update Date: | 09/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 017985 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |