Provider Demographics
NPI:1710054168
Name:MUIR, GLADYS (RN, CNM, RNFA)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:MUIR
Suffix:
Gender:F
Credentials:RN, CNM, RNFA
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 36
Mailing Address - Street 2:
Mailing Address - City:ANGWIN
Mailing Address - State:CA
Mailing Address - Zip Code:94508-0036
Mailing Address - Country:US
Mailing Address - Phone:707-965-9945
Mailing Address - Fax:
Practice Address - Street 1:1 ANGWIN AVE
Practice Address - Street 2:
Practice Address - City:ANGWIN
Practice Address - State:CA
Practice Address - Zip Code:94508-9713
Practice Address - Country:US
Practice Address - Phone:707-965-7604
Practice Address - Fax:707-965-6499
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 338558 CNM 892367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANMW0008920OtherMEDICAL NUMBER