Healthcare Provider Details

I. General information

NPI: 1891040135
Provider Name (Legal Business Name): ANNE BRIDGET GLEASON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 EAST 223RD ST SOUTH BAY FAMILY HEALTH CARE
CARSON CA
90745
US

IV. Provider business mailing address

270 EAST 223RD ST SOUTH BAY FAMILY HEALTH CARE
CARSON CA
90745
US

V. Phone/Fax

Practice location:
  • Phone: 310-549-7259
  • Fax:
Mailing address:
  • Phone: 310-549-7259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2274503
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22900
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: