Provider Demographics
NPI:1992035174
Name:GLEASON, MARY (MARY GLEASON, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:GLEASON
Suffix:
Gender:F
Credentials:MARY GLEASON, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5255 LOUGHBORO RD NW
Mailing Address - Street 2:SIBLEY MEMORIAL HOSPITAL - PAIN CENTER
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-2633
Mailing Address - Country:US
Mailing Address - Phone:202-537-4589
Mailing Address - Fax:
Practice Address - Street 1:5255 LOUGHBORO RD NW
Practice Address - Street 2:SIBLEY MEMORIAL HOSPITAL - PAIN CENTER
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2633
Practice Address - Country:US
Practice Address - Phone:202-537-4589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1006509163W00000X, 363LF0000X
VA0001209828163W00000X
MDAC000760363LF0000X, 163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WX0200XNursing Service ProvidersRegistered NurseOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD036182800Medicaid
MD183495ZAWAMedicare PIN