Provider Demographics
NPI:1598084543
Name:GLORIOSO, AMANDA L (RN BSN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:GLORIOSO
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8550 WATERFORD AVE UNIT 8
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228
Mailing Address - Country:US
Mailing Address - Phone:414-617-5376
Mailing Address - Fax:
Practice Address - Street 1:8550 W WATERFORD AVE
Practice Address - Street 2:UNIT 8
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-2327
Practice Address - Country:US
Practice Address - Phone:414-617-5376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI144712-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health