Basic Information
| Provider Information | |||||||||
| NPI: | 1356313118 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | GLORIA | ||||||||
| MiddleName: | HARE | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1405 CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | FT WAINWRIGHT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997031377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073561819 | ||||||||
| FaxNumber: | 9073534850 | ||||||||
| Practice Location | |||||||||
| Address1: | 1060 GAFFNEY RD | ||||||||
| Address2: | |||||||||
| City: | FT WAINWRIGHT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997035001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073531207 | ||||||||
| FaxNumber: | 9073534850 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | 167019 | NC | Y | Nursing Service Providers | Registered Nurse | General Practice |
No ID Information.