Healthcare Provider Details

I. General information

NPI: 1649335225
Provider Name (Legal Business Name): GLADELL E CIMA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GLADELL E SMITH ARNP

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 STEVENS AVE
LOUISVILLE KY
40205-1044
US

IV. Provider business mailing address

9900 BREN RD E
MINNETONKA MN
55343-9664
US

V. Phone/Fax

Practice location:
  • Phone: 502-451-7330
  • Fax:
Mailing address:
  • Phone: 502-727-4931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2816P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: