Provider Demographics
NPI:1114409059
Name:GLECKMAN, LANA (RN)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:GLECKMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 GRANADA DR
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-2010
Mailing Address - Country:US
Mailing Address - Phone:415-847-4617
Mailing Address - Fax:
Practice Address - Street 1:200 GRANADA DR
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-2010
Practice Address - Country:US
Practice Address - Phone:415-847-4617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95174722163W00000X
CA95019148363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse