Basic Information
| Provider Information | |||||||||
| NPI: | 1346259702 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLUYS | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JUSSEAUME | ||||||||
| OtherFirstName: | MARIA | ||||||||
| OtherMiddleName: | T | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5400 S MIAMI BLVD | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277038465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199411911 | ||||||||
| FaxNumber: | 9199941901 | ||||||||
| Practice Location | |||||||||
| Address1: | 5400 S MIAMI BLVD | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277038465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199411911 | ||||||||
| FaxNumber: | 9199411901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 07/16/2008 | ||||||||
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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 | 363A00000X | 001000223 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 2624973 | 01 | NC | UHC | OTHER |