Basic Information
| Provider Information | |||||||||
| NPI: | 1164726139 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLEASON | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3530 W 4TH ST | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507014503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192332701 | ||||||||
| FaxNumber: | 3192367993 | ||||||||
| Practice Location | |||||||||
| Address1: | 3530 W 4TH ST | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507014503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192332701 | ||||||||
| FaxNumber: | 3192367993 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2011 | ||||||||
| LastUpdateDate: | 02/28/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 115265 | IA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | A115265 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.