Provider Demographics
NPI:1649335225
Name:CIMA, GLADELL E (ARNP)
Entity type:Individual
Prefix:
First Name:GLADELL
Middle Name:E
Last Name:CIMA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:GLADELL
Other - Middle Name:E
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:9900 BREN RD E
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-9664
Mailing Address - Country:US
Mailing Address - Phone:502-727-4931
Mailing Address - Fax:
Practice Address - Street 1:1705 STEVENS AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1044
Practice Address - Country:US
Practice Address - Phone:502-451-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2816P363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK147300Medicare PIN