1932357662 NPI number — MRS. CAMILLE RICE GLIDDEN CPNP

Table of content: MRS. CAMILLE RICE GLIDDEN CPNP (NPI 1932357662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932357662 NPI number — MRS. CAMILLE RICE GLIDDEN CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLIDDEN
Provider First Name:
CAMILLE
Provider Middle Name:
RICE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RICE
Provider Other First Name:
CAMILLE
Provider Other Middle Name:
BOUDREAUX
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932357662
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3411 GRAYSTONE PL SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONOVER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28613-8200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-328-1118
Provider Business Mailing Address Fax Number:
828-328-1119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3411 GRAYSTONE PLACE SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONOVER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28613-8200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-328-1118
Provider Business Practice Location Address Fax Number:
828-328-1119
Provider Enumeration Date:
09/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  5006567 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com