Provider Demographics
NPI:1568876043
Name:GLEASON, BETHANY CLAIRE
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:CLAIRE
Last Name:GLEASON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:BETHANY
Other - Middle Name:CLAIRE
Other - Last Name:LOOMIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL PLZ
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3602
Mailing Address - Country:US
Mailing Address - Phone:203-276-7070
Mailing Address - Fax:203-276-5565
Practice Address - Street 1:1 HOSPITAL PLZ
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3602
Practice Address - Country:US
Practice Address - Phone:203-276-7070
Practice Address - Fax:203-276-5565
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT89268163W00000X
CT5843363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse