Provider Demographics
NPI:1700072857
Name:STRAUGHN, GLORIA GIAVENO (ARNP, CS, BC, PHD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:GIAVENO
Last Name:STRAUGHN
Suffix:
Gender:F
Credentials:ARNP, CS, BC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:497 HOOKSETT RD
Mailing Address - Street 2:SUITE 325
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2632
Mailing Address - Country:US
Mailing Address - Phone:603-224-0101
Mailing Address - Fax:603-668-2191
Practice Address - Street 1:722 ROUTE 3A
Practice Address - Street 2:SUITE 15
Practice Address - City:BOW
Practice Address - State:NH
Practice Address - Zip Code:03304-4010
Practice Address - Country:US
Practice Address - Phone:603-224-0101
Practice Address - Fax:603-668-2191
Is Sole Proprietor?:No
Enumeration Date:2007-09-22
Last Update Date:2007-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH020052-21163WP0809X
NH020052-23-08363LP0808X
NH364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30340863Medicaid