Healthcare Provider Details

I. General information

NPI: 1407808074
Provider Name (Legal Business Name): GEORGE H. GLADE SR. ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: WOODY GLADE NC, MN

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 WESTLAKE AVE N STE 303
SEATTLE WA
98109-2782
US

IV. Provider business mailing address

1800 WESTLAKE AVE N. #303
SEATTLE WA
98109
US

V. Phone/Fax

Practice location:
  • Phone: 206-938-9580
  • Fax: 206-938-1173
Mailing address:
  • Phone: 206-938-9580
  • Fax: 206-938-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30004465
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP30004465
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00114137
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: