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NPI Code Detail

MEDICARE: GRACE GLEASON APN

MEDICARE: GRACE GLEASON APN
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 Practitioner822282NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11982991576OTHERILTRICARE STANDARD
2041346210OTHERILNURSE REGISTERED PROFESSIONAL
3209008861OTHERILCERTIFIED NURSE PRACITIONER

General Provider Information

NPI Number : 1982991576
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE GLEASON APN
Provider Business Mailing Address
First Line : PO BOX 3299
Second Line :
City : CARSON CITY
State : NV
Zip : 89702-3299
Country : US
Telephone Number : 775-222-0042
Fax Number :
Provider Business Practice Location Address
First Line : 3050 N ORMSBY BLVD
Second Line :
City : CARSON CITY
State : NV
Zip : 89703-8378
Country : US
Telephone Number : 775-781-0092
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2011
Last Update Date : 10/04/2019

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