Provider Demographics
NPI:1669741922
Name:GLEASON, KRISTEN DIANA (MED)
Entity type:Individual
Prefix:MR
First Name:KRISTEN
Middle Name:DIANA
Last Name:GLEASON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3969 LURLINE DR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-4005
Mailing Address - Country:US
Mailing Address - Phone:267-240-5829
Mailing Address - Fax:
Practice Address - Street 1:3969 LURLINE DR
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-4005
Practice Address - Country:US
Practice Address - Phone:267-240-5829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional