Healthcare Provider Details

I. General information

NPI: 1679524508
Provider Name (Legal Business Name): GLENDA GIAMPOLO ZANE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 EOFF ST
WHEELING WV
26003-3823
US

IV. Provider business mailing address

5 HOLLAND STE 101
IRVINE CA
92618-2568
US

V. Phone/Fax

Practice location:
  • Phone: 304-234-8663
  • Fax: 304-234-8960
Mailing address:
  • Phone: 949-588-2190
  • Fax: 949-588-2199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA02444
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: