Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 263261 | NY |
N | 207RC0200X | Critical Care Medicine | N0791 | TX |
NPI | 1023086881 |
---|---|
Provider Name | Bonnie Theresa Gleason |
First Address | Amherst, NY 14221-2616 |
Second Address | Buffalo, NY 14220-2039 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 15/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H38588 | (02) |