Provider Demographics
NPI:1073227369
Name:GLEUSSNER, NICOLE M (CNM)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:GLEUSSNER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14577
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-7577
Mailing Address - Country:US
Mailing Address - Phone:330-758-2041
Mailing Address - Fax:330-758-2042
Practice Address - Street 1:7067 TIFFANY BLVD STE 220
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-1981
Practice Address - Country:US
Practice Address - Phone:330-758-2041
Practice Address - Fax:330-758-2042
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNM.0019552176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife