Provider Demographics
NPI:1073852877
Name:GLIDEWELL, LEANNE C (APN)
Entity Type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:C
Last Name:GLIDEWELL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16221 SAINT VINCENT WAY
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-9072
Mailing Address - Country:US
Mailing Address - Phone:501-552-8150
Mailing Address - Fax:501-552-8199
Practice Address - Street 1:16221 SAINT VINCENT WAY
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-9072
Practice Address - Country:US
Practice Address - Phone:501-552-8150
Practice Address - Fax:501-552-8199
Is Sole Proprietor?:No
Enumeration Date:2013-02-14
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003820363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA003820OtherSTATE APN LICENSE