MEDICARE: CYNTHIA GAY GLIDEWELL RN BS

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
1	163W00000X	Registered Nurse	R20739	AR

General Provider Information

NPI Number	:	1700022217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA GAY GLIDEWELL RN BS

Provider Business Mailing Address
First Line	:	1900 OFARRELL ST
Second Line	:	SUITE 250
City	:	SAN MATEO
State	:	CA
Zip	:	94403-1386
Country	:	US
Telephone Number	:	650-645-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 OFARRELL ST
Second Line	:	SUITE 250
City	:	SAN MATEO
State	:	CA
Zip	:	94403-1386
Country	:	US
Telephone Number	:	650-645-1100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2009
Last Update Date	:	01/05/2009

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