Provider Demographics
NPI:1881332419
Name:GLEASON, BRIANNA SHAE (CRS)
Entity type:Individual
Prefix:MISS
First Name:BRIANNA
Middle Name:SHAE
Last Name:GLEASON
Suffix:
Gender:F
Credentials:CRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-2518
Mailing Address - Country:US
Mailing Address - Phone:717-273-8000
Mailing Address - Fax:717-273-8244
Practice Address - Street 1:3030 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-2518
Practice Address - Country:US
Practice Address - Phone:717-273-8000
Practice Address - Fax:717-273-8244
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA17325171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty