Provider Demographics
NPI:1699248369
Name:GLEATON, SHANTE (APRN)
Entity type:Individual
Prefix:
First Name:SHANTE
Middle Name:
Last Name:GLEATON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2571 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2029
Mailing Address - Country:US
Mailing Address - Phone:803-610-4199
Mailing Address - Fax:803-830-7157
Practice Address - Street 1:2571 FOREST DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2029
Practice Address - Country:US
Practice Address - Phone:803-610-4199
Practice Address - Fax:803-830-7157
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-06
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22257363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty