Provider Demographics
NPI:1609588854
Name:GLEASON, NORA SULLIVAN (CRNP)
Entity Type:Individual
Prefix:
First Name:NORA
Middle Name:SULLIVAN
Last Name:GLEASON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:NORA
Other - Middle Name:SULLIVAN
Other - Last Name:TAMULEVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:726 S DECKER AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-3945
Mailing Address - Country:US
Mailing Address - Phone:301-642-4772
Mailing Address - Fax:
Practice Address - Street 1:301 SAINT PAUL ST STE 519
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2102
Practice Address - Country:US
Practice Address - Phone:301-642-4772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR197561363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner