Provider Demographics
NPI:1396118238
Name:GLATT, CORINNA
Entity type:Individual
Prefix:
First Name:CORINNA
Middle Name:
Last Name:GLATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CORINNA
Other - Middle Name:
Other - Last Name:GLATT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3100 N 11TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-1210
Mailing Address - Country:US
Mailing Address - Phone:701-712-0066
Mailing Address - Fax:701-712-0077
Practice Address - Street 1:3100 N 11TH ST STE 1
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-1210
Practice Address - Country:US
Practice Address - Phone:701-712-0066
Practice Address - Fax:701-712-0077
Is Sole Proprietor?:No
Enumeration Date:2015-10-31
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR31134363LA2200X, 363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology