Healthcare Provider Details

I. General information

NPI: 1497704597
Provider Name (Legal Business Name): DONNA J GLEASON NP, CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7328 N 22ND ST
PHOENIX AZ
85020-4753
US

IV. Provider business mailing address

PO BOX 32776
PHOENIX AZ
85064-2776
US

V. Phone/Fax

Practice location:
  • Phone: 480-545-2610
  • Fax: 480-545-2673
Mailing address:
  • Phone: 480-545-2610
  • Fax: 480-545-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN055609
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP5523
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: