Healthcare Provider Details

I. General information

NPI: 1598139784
Provider Name (Legal Business Name): GLORIA CLAMPITT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2015
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4719 MOSS CREEK CT
INDIANAPOLIS IN
46237-2940
US

IV. Provider business mailing address

4719 MOSS CREEK CT
INDIANAPOLIS IN
46237-2940
US

V. Phone/Fax

Practice location:
  • Phone: 732-762-3206
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024173260
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN6540037
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: