Provider Demographics
NPI:1871873810
Name:GLEASON, ANGELA D (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:GLEASON
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11920 KINGSVILLE DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-2308
Mailing Address - Country:US
Mailing Address - Phone:832-860-8648
Mailing Address - Fax:
Practice Address - Street 1:11920 KINGSVILLE DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-2308
Practice Address - Country:US
Practice Address - Phone:832-860-8648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX691702163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant