Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 19617 | NE |
NPI | 1043214588 |
---|---|
Provider Name | Michele L Gleason |
First Address | Grand Island, NE 68803-4960 |
Second Address | Grand Island, NE 68803-4960 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47082399313 | (05) | NE |
G50615 | (02) | NE |