Provider Demographics
NPI:1780881151
Name:BOARDMAN, GLORIA A (MSN RN APN)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:A
Last Name:BOARDMAN
Suffix:
Gender:F
Credentials:MSN RN APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:304 CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973
Mailing Address - Country:US
Mailing Address - Phone:302-629-4855
Mailing Address - Fax:
Practice Address - Street 1:18 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1446
Practice Address - Country:US
Practice Address - Phone:302-424-7300
Practice Address - Fax:302-422-1363
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEL1-0018945163W00000X
DELI-0000100364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163W00000XNursing Service ProvidersRegistered Nurse