Provider Demographics
NPI:1114409059
Name:GLECKMAN, LANA (RN)
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:GLECKMAN
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 1:600 GATEWAY BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-7014
Mailing Address - Country:US
Mailing Address - Phone:844-838-3322
Mailing Address - Fax:858-430-2741
Practice Address - Street 1:600 GATEWAY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-7014
Practice Address - Country:US
Practice Address - Phone:844-838-3322
Practice Address - Fax:858-430-2741
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95174722163W00000X
CA95019148363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse