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NPI Code Detail

MEDICARE: DEBORAH GLEESON CRNP

MEDICARE: DEBORAH GLEESON CRNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse PractitionerSP007419PA

General Provider Information

NPI Number : 1174512024
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH GLEESON CRNP
Provider Business Mailing Address
First Line : 1674 N WALES RD
Second Line :
City : BLUE BELL
State : PA
Zip : 19422-3689
Country : US
Telephone Number : 610-308-1237
Fax Number : 215-707-3946
Provider Business Practice Location Address
First Line : 9900 BREN RD E
Second Line :
City : MINNETONKA
State : MN
Zip : 55343-9664
Country : US
Telephone Number : 215-707-8484
Fax Number : 215-707-3946
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2005
Last Update Date : 04/07/2021

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