Provider Demographics
NPI:1407808074
Name:GLADE, GEORGE H SR (ARNP)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:H
Last Name:GLADE
Suffix:SR
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:WOODY
Other - Middle Name:
Other - Last Name:GLADE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NC, MN
Mailing Address - Street 1:1800 WESTLAKE AVE N. #303
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109
Mailing Address - Country:US
Mailing Address - Phone:206-938-9580
Mailing Address - Fax:206-938-1173
Practice Address - Street 1:1800 WESTLAKE AVE N STE 303
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2782
Practice Address - Country:US
Practice Address - Phone:206-938-9580
Practice Address - Fax:206-938-1173
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00114137163W00000X
WAAP30004465363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA94133UOtherREGENCE BLUE SHIELD PIN
WA9622705Medicaid
WA9622705Medicaid
WA94133UOtherREGENCE BLUE SHIELD PIN
S86364Medicare UPIN