Provider Demographics
NPI:1649387572
Name:GLANDT, SHARON A (NP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:A
Last Name:GLANDT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2290
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54221-2290
Mailing Address - Country:US
Mailing Address - Phone:920-320-2591
Mailing Address - Fax:920-320-4155
Practice Address - Street 1:1235 S 24TH ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-5516
Practice Address - Country:US
Practice Address - Phone:920-320-6620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI58411208800000X
WI669363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43847200Medicaid
WI0373980001OtherDMERC
WI1003310OtherTOUCHPOINT
WI390806395OtherCIGNA
WI10485OtherNETWORK HEALTH PLAN
WI500004071OtherRAILROAD MEDICARE
WI0373980001OtherDMERC
WI38235-0011Medicare ID - Type Unspecified