1437279791 NPI number — GLORIANE BOND HARGRAVE MSN, APRN,FNP-BC

Table of content: GLORIANE BOND HARGRAVE MSN, APRN,FNP-BC (NPI 1437279791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437279791 NPI number — GLORIANE BOND HARGRAVE MSN, APRN,FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARGRAVE
Provider First Name:
GLORIANE
Provider Middle Name:
BOND
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, APRN,FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOND
Provider Other First Name:
GLORIANE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437279791
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
76 ORINDA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONROE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77304-1118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 E DAVIS ST
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
CONROE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77301-3102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-766-1888
Provider Business Practice Location Address Fax Number:
936-539-4668
Provider Enumeration Date:
03/30/2007

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: 363LF0000X , with the licence number:  AP106104 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 144410101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 144410102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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