Healthcare Provider Details

I. General information

NPI: 1790776458
Provider Name (Legal Business Name): MARIAN L GLANDT NP. WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 CEDAR PLAZA PKWY STE 230
SAINT LOUIS MO
63128-3854
US

IV. Provider business mailing address

5000 CEDAR PLAZA PKWY STE 230
SAINT LOUIS MO
63128-3854
US

V. Phone/Fax

Practice location:
  • Phone: 314-489-7272
  • Fax: 314-849-7347
Mailing address:
  • Phone: 314-489-7272
  • Fax: 314-849-7347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number054474
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: