Individual
MRS. DIANA GAMEL GLIDDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP, GNP
Contact information
Practice address
3147 SW SAM JACKSON PARK RD, OHSU INTERNAL MEDICINE AND GERIATRICS CLINIC, PORTLAND, OR 97239-3011
(503) 494-8562
(503) 418-5505
Mailing address
3147 SW SAM JACKSON PARK RD, OHSU INTERNAL MEDICINE AND GERIATRICS CLINIC, PORTLAND, OR 97239-3011
(503) 494-8562
(503) 418-5505
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
275124
MA
363LA2200X
Adult Health Nurse Practitioner
Primary
201507841NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0719251
—
MA
Enumeration date
07/01/2008
Last updated
12/07/2015
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