Active NPI
Tammy Lynne Glidewell, RN
- Registered Nurse
- Mullan, ID
National Provider Identifier
1154664365
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN00114868
- Practice address
- 439 2ND Street
Mullan, ID 83846 - Phone
- (509) 468-2542
- NPI assigned
- Apr 5, 2013
- Last updated
- Jan 14, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN00114868 | WA | Primary |
Addresses
Primary practice location
439 2ND Street
Mullan, ID 83846
Mailing address
PO Box 631
Mullan, ID 83846-0631
Phone (509) 468-2542
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN00114868 | WA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1365120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578960000000",
"number": "1154664365",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 631",
"city": "MULLAN",
"state": "ID",
"postal_code": "838460631",
"telephone_number": "509-468-2542"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "439 2ND STREET",
"city": "MULLAN",
"state": "ID",
"postal_code": "83846",
"telephone_number": "509-468-2542"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLIDEWELL",
"first_name": "TAMMY",
"middle_name": "LYNNE",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-04-05",
"last_updated": "2020-01-14",
"certification_date": "2020-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "WA",
"license": "RN00114868",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mullan, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.