Provider Demographics
NPI:1538354907
Name:GLADE, MARY JANE (APRN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JANE
Last Name:GLADE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:JANE
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:7155 KENTWELL LN STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6768
Mailing Address - Country:US
Mailing Address - Phone:402-858-2052
Mailing Address - Fax:
Practice Address - Street 1:7155 KENTWELL LN STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6768
Practice Address - Country:US
Practice Address - Phone:402-858-2052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110857363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily