Provider Demographics
NPI:1881737286
Name:GLATLEIDER, M PAULINE (CNM)
Entity type:Individual
Prefix:MS
First Name:M
Middle Name:PAULINE
Last Name:GLATLEIDER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:POLLI
Other - Middle Name:
Other - Last Name:GLATLEIDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNM
Mailing Address - Street 1:1537 ANGELUS AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-1410
Mailing Address - Country:US
Mailing Address - Phone:323-665-6591
Mailing Address - Fax:323-665-0936
Practice Address - Street 1:200 UCLA MEDICAL PLZ
Practice Address - Street 2:SUITE 430
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-8344
Practice Address - Country:US
Practice Address - Phone:310-794-7274
Practice Address - Fax:310-794-7436
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANMW 763367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife