Provider Demographics
NPI:1316345143
Name:GLAD, MARIA J (MS FNP-BC)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:J
Last Name:GLAD
Suffix:
Gender:F
Credentials:MS FNP-BC
Other - Prefix:MRS
Other - First Name:MARIA
Other - Middle Name:GLAD
Other - Last Name:RYNKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSFNP-BC
Mailing Address - Street 1:260 WESTERN AVENUE
Mailing Address - Street 2:B
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2432
Mailing Address - Country:US
Mailing Address - Phone:207-272-3138
Mailing Address - Fax:
Practice Address - Street 1:278 VERANDA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103
Practice Address - Country:US
Practice Address - Phone:207-272-3138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP101081133NN1002X, 174H00000X, 405300000X, 363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No174H00000XOther Service ProvidersHealth Educator
No405300000XOther Service ProvidersPrevention Professional