Provider Demographics
NPI:1487692018
Name:GLEESON, CYNTHIA (FNP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:GLEESON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 SISKEY PKWY
Mailing Address - Street 2:MINUTECLINIC
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-3222
Mailing Address - Country:US
Mailing Address - Phone:704-849-2271
Mailing Address - Fax:
Practice Address - Street 1:3310 SISKEY PKWY
Practice Address - Street 2:MINUTECLINIC
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-3222
Practice Address - Country:US
Practice Address - Phone:704-849-2271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201446363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2802305AMedicare UPIN
NC2802305Medicare ID - Type Unspecified