Provider Demographics
NPI:1366816589
Name:GLOOD, HEIDI ANN (CNP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:ANN
Last Name:GLOOD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:ANN
Other - Last Name:HAWK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5410 SHERIDAN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-9208
Mailing Address - Country:US
Mailing Address - Phone:605-348-4141
Mailing Address - Fax:605-342-7880
Practice Address - Street 1:5410 SHERIDAN LAKE RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-9208
Practice Address - Country:US
Practice Address - Phone:605-348-4141
Practice Address - Fax:605-342-7880
Is Sole Proprietor?:No
Enumeration Date:2015-11-26
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP001042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily