Provider Demographics
NPI:1700302825
Name:GLEASON, PAULETTE M (ARNP)
Entity type:Individual
Prefix:
First Name:PAULETTE
Middle Name:M
Last Name:GLEASON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:PAULETTE
Other - Middle Name:M
Other - Last Name:PELZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1455
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50306-1455
Mailing Address - Country:US
Mailing Address - Phone:515-471-9300
Mailing Address - Fax:515-471-9320
Practice Address - Street 1:1303 11TH AVE
Practice Address - Street 2:
Practice Address - City:MANSON
Practice Address - State:IA
Practice Address - Zip Code:50563-5065
Practice Address - Country:US
Practice Address - Phone:712-469-3307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA091958363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily