Provider Demographics
NPI:1619638327
Name:HENTZ-KALNOSKI, GLORIA JEAN (LPN)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:JEAN
Last Name:HENTZ-KALNOSKI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:864 JAY ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046-1924
Mailing Address - Country:US
Mailing Address - Phone:717-507-6250
Mailing Address - Fax:
Practice Address - Street 1:3030 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-2518
Practice Address - Country:US
Practice Address - Phone:717-273-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN093822L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse