Healthcare Provider Details

I. General information

NPI: 1306171335
Provider Name (Legal Business Name): GLORIA ANN HUFSTETLER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GLORIA ANN ALEXANDER

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 HOMEWORTH AVE
PAINESVILLE OH
44077-4308
US

IV. Provider business mailing address

564 HOMEWORTH AVE
PAINESVILLE OH
44077-4308
US

V. Phone/Fax

Practice location:
  • Phone: 440-350-9938
  • Fax:
Mailing address:
  • Phone: 440-350-9938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN125123 IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: