Provider Demographics
NPI:1306171335
Name:HUFSTETLER, GLORIA ANN (LPN)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:ANN
Last Name:HUFSTETLER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:ANN
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:564 HOMEWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-4308
Mailing Address - Country:US
Mailing Address - Phone:440-350-9938
Mailing Address - Fax:
Practice Address - Street 1:564 HOMEWORTH AVE
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-4308
Practice Address - Country:US
Practice Address - Phone:440-350-9938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN125123 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse