Doctor Name: | NEELY A GLADD |
NPI Number: | 1043321672 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 71001997A |
Business Practice Address: | 524 Branch Ct Columbia City, IN - 467251323 |
Business Phone Number: | 2602446203 |
Business Fax Number: | 2602445212 |
Mailing Address: | 524 Branch Ct, COLUMBIA CITY |
State: | IN |
Postal Code: | 467251323 |
Phone Number: | 2602446203 |
Fax Number: | 2602445212 |
NPI Enumeration Date: | 08/31/2006 |
NPI Last Update Date: | 04/18/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 71001997A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |