| Doctor Name: | MS. KATHLEEN ZILLNER GLASS |
| NPI Number: | 1275766651 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ANP-BC |
| License Number: | F304889-1 |
| Business Practice Address: | 12 Center St Suite One Fredonia, NY - 140631769 |
| Business Phone Number: | 7166792233 |
| Business Fax Number: | 7166724163 |
| Mailing Address: | 12 Center St, Suite One FREDONIA |
| State: | NY |
| Postal Code: | 140631769 |
| Phone Number: | 7166792233 |
| Fax Number: | 7166724163 |
| NPI Enumeration Date: | 09/01/2009 |
| NPI Last Update Date: | 05/01/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | F304889-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |