Provider Demographics
NPI:1821174145
Name:GLANTZ, KATHERYNE W (DPM)
Entity Type:Individual
Prefix:DR
First Name:KATHERYNE
Middle Name:W
Last Name:GLANTZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:KATHERYNE
Other - Middle Name:WALTZ
Other - Last Name:GLANTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2345 E PRATER WAY
Mailing Address - Street 2:#315
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-9639
Mailing Address - Country:US
Mailing Address - Phone:775-331-3668
Mailing Address - Fax:775-331-3649
Practice Address - Street 1:2345 E PRATER WAY
Practice Address - Street 2:315
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-9639
Practice Address - Country:US
Practice Address - Phone:775-331-3668
Practice Address - Fax:775-331-3649
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9103A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVU26053Medicare UPIN
NV1154880001Medicare NSC
NVVDPM9103AMedicare PIN