Provider Demographics
NPI:1891252987
Name:GLEASON, ELIZABETH ASHLEY (CNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ASHLEY
Last Name:GLEASON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2449 ROSS MILLVILLE RD STE B50
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-8952
Mailing Address - Country:US
Mailing Address - Phone:513-737-6068
Mailing Address - Fax:513-737-6681
Practice Address - Street 1:2449 ROSS MILLVILLE RD STE B50
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-8952
Practice Address - Country:US
Practice Address - Phone:513-737-6068
Practice Address - Fax:513-737-6681
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024305363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0337332Medicaid