Provider Demographics
NPI:1659434959
Name:GLEASON, ERIN ROSE (RN, NP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:ROSE
Last Name:GLEASON
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:ROSE
Other - Last Name:BERBERIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, NP
Mailing Address - Street 1:9300 VALLEY CHILDRENS PL
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-8761
Mailing Address - Country:US
Mailing Address - Phone:559-353-8119
Mailing Address - Fax:559-353-7286
Practice Address - Street 1:9300 VALLEY CHILDRENS PL
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-8761
Practice Address - Country:US
Practice Address - Phone:559-353-8119
Practice Address - Fax:559-353-7286
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA536587163W00000X
CA12684363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner