Provider Demographics
NPI:1780573436
Name:GLANDON, NATHANIEL GENE
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:GENE
Last Name:GLANDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6028 S 42ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-3703
Mailing Address - Country:US
Mailing Address - Phone:402-714-6369
Mailing Address - Fax:
Practice Address - Street 1:6028 S 42ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-3703
Practice Address - Country:US
Practice Address - Phone:402-714-6369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEH13194305171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor