Provider Demographics
NPI:1952337420
Name:GOBELMAN, GLENDA A (APN)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:A
Last Name:GOBELMAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:GLENDA
Other - Middle Name:JULIANNE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:850 HARVARD WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2055
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-5496
Practice Address - Street 1:6536 S MCCARRAN BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6168
Practice Address - Country:US
Practice Address - Phone:775-982-8255
Practice Address - Fax:775-982-8251
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN13894163W00000X
NVAPRN00162363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
11832689OtherCAQH
NV1952337420Medicaid
NV1952337420Medicaid
NVV103218Medicare PIN