Provider Demographics
NPI:1285734004
Name:GLADD, DIANNE LYNN (RN)
Entity type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:LYNN
Last Name:GLADD
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:23 FARRINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29860
Mailing Address - Country:US
Mailing Address - Phone:803-279-0659
Mailing Address - Fax:
Practice Address - Street 1:#1 FREEDOM WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904
Practice Address - Country:US
Practice Address - Phone:706-733-0188
Practice Address - Fax:706-823-3980
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAR55182163WN0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0800XNursing Service ProvidersRegistered NurseNeuroscience