Healthcare Provider Details

I. General information

NPI: 1649387572
Provider Name (Legal Business Name): SHARON A GLANDT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 S 24TH ST
MANITOWOC WI
54220-5516
US

IV. Provider business mailing address

PO BOX 2290
MANITOWOC WI
54221-2290
US

V. Phone/Fax

Practice location:
  • Phone: 920-320-6620
  • Fax:
Mailing address:
  • Phone: 920-320-2591
  • Fax: 920-320-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number669
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number58411
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: