Basic Information
| Provider Information | |||||||||
| NPI: | 1649387572 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GLANDT | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2290 | ||||||||
| Address2: | |||||||||
| City: | MANITOWOC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 542212290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9203202591 | ||||||||
| FaxNumber: | 9203204155 | ||||||||
| Practice Location | |||||||||
| Address1: | 1235 S 24TH ST | ||||||||
| Address2: | |||||||||
| City: | MANITOWOC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 542205516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9203206620 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 06/12/2012 | ||||||||
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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 | 208800000X | 58411 | WI | N | Allopathic & Osteopathic Physicians | Urology | 363L00000X | 669 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 43847200 | 05 | WI | MEDICAID | 0373980001 | 01 | WI | DMERC | OTHER | 1003310 | 01 | WI | TOUCHPOINT | OTHER | 390806395 | 01 | WI | CIGNA | OTHER | 10485 | 01 | WI | NETWORK HEALTH PLAN | OTHER | 500004071 | 01 | WI | RAILROAD MEDICARE | OTHER |