Healthcare Provider Details

I. General information

NPI: 1740572627
Provider Name (Legal Business Name): JULIE ALAYNE GLADNEY LPN, IBCLC, RLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 COLUMBUS RD STE 105
ATHENS OH
45701-1393
US

IV. Provider business mailing address

PO BOX 393
ATHENS OH
45701-0393
US

V. Phone/Fax

Practice location:
  • Phone: 740-818-8871
  • Fax: 844-442-5114
Mailing address:
  • Phone: 740-818-8871
  • Fax: 740-447-9605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN 142244
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number108-85240
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License NumberL-20141
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-20141
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: