Provider Demographics
NPI:1013689744
Name:MCGLONE, KHRISTEEN DANIELLE (FNP)
Entity Type:Individual
Prefix:MS
First Name:KHRISTEEN
Middle Name:DANIELLE
Last Name:MCGLONE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:KHRISTEEN
Other - Middle Name:DANIELLE
Other - Last Name:BORAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:4690 BROOK RD NW
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8211
Mailing Address - Country:US
Mailing Address - Phone:740-409-2031
Mailing Address - Fax:
Practice Address - Street 1:122 GRACELAND BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1530
Practice Address - Country:US
Practice Address - Phone:614-558-4881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0027985363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily