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General NPI Number Information
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NPI Number | 1558992149
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Entity Type | Individual
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Provider Name | TAWNI SUE GLANDER APRN
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Gender | Female
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Dates
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Enumeration Date | 01/31/2020
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Last Update Date | 09/18/2020
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Provider Practice Location Address
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Address Line | 7800 DALLAS ST
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City | FORT SMITH
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State | AR
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Zip | 72903-4278
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Country | US
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Telephone | 479-314-4940
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Fax |
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Provider Business Mailing Address
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Address Line | 1339 WILLOWBROOK CIR
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City | FORT SMITH
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State | AR
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Zip | 72908-9077
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 102811
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 122834
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License Number State | AR
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