Provider Demographics
NPI:1063532489
Name:HART, GLORIA J (RN)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:J
Last Name:HART
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 LEBANON HWY
Mailing Address - Street 2:PO BOX 319
Mailing Address - City:CARTHAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37030-2955
Mailing Address - Country:US
Mailing Address - Phone:615-735-5320
Mailing Address - Fax:615-735-5321
Practice Address - Street 1:130 LEBANON HWY
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-2955
Practice Address - Country:US
Practice Address - Phone:615-735-5320
Practice Address - Fax:615-735-5321
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000021951163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3241169Medicare ID - Type Unspecified
3241169Medicare ID - Type Unspecified