GLORIOUS LATRIC WILSON-REYNOLDS (NPI# 1376898320) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376898320 |
| Entity Type | Individual |
| Full Name | GLORIOUS LATRIC WILSON-REYNOLDS |
| Credential | CPNP |
| Practice Address |
1509 State St La Porte IN 46350-3115 |
| Mailing Address |
2022 Kelle Dr Chesterton IN 46304-8708 |
| Practice Telephone | 2193243431 |
| Practice Fax Number | 2193623802 |
| Mailing Telephone | 2193262312 |
| Mailing Fax Number | 2193262584 |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2020-09-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
71005286A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
209008737 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1509 STATE ST |
| City | LA PORTE |
| State | IN |
| Zip Code | 46350-3115 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699396382 | Ashley Martin | Occupational Therapist | 1509 State St, La Porte, IN 46350-3115 | 2020-05-04 |
| 1023659018 | Rachel Tomaszewski | Physical Therapist | 1509 State St, La Porte, IN 46350-3115 | 2019-10-01 |
| 1770139057 | Dana Jo Hammons | Speech-Language Pathologist | 1509 State St, La Porte, IN 46350-3115 | 2019-08-13 |
| 1497301964 | Suzanne Marie Hanna | Advanced Practice Midwife | 1509 State St, La Porte, IN 46350-3115 | 2019-08-12 |
| 1588229504 | Jordyn Headley | Speech-Language Pathologist | 1509 State St, La Porte, IN 46350-3115 | 2019-05-06 |
| 1811552110 | Breanne Blankenship | Speech-Language Pathologist | 1509 State St, La Porte, IN 46350-3115 | 2019-05-02 |
| 1104481480 | Krystina Gloria Donoghue | Occupational Therapist | 1509 State St, La Porte, IN 46350-3115 | 2019-05-02 |
| 1649653601 | Melanie Ann Abner | Nurse Practitioner | 1509 State St, La Porte, IN 46350-3115 | 2015-07-08 |
| 1528447299 | Ashley Gacsy | Nurse Practitioner | 1509 State St, La Porte, IN 46350-3115 | 2015-05-27 |
| 1376949727 | Heather Fix | Nurse Practitioner | 1509 State St, La Porte, IN 46350-3115 | 2014-11-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871139246 | Carolyn Ann Perra | Pharmacist | 55 Pine Lake S.c., Laporte, IN 46350 | 2019-11-20 |
| 1306496492 | Trinity Healthcare Inc. | Occupational Therapist | 2002 Andrew Avenue, Laporte, IN 46350 | 2019-09-19 |
| 1184136665 | Diane Margaret Rich | Physical Therapist | 1643 S Willow Bend Dr, La Porte, IN 46350 | 2017-10-24 |
| 1114460102 | Judith Marie Fitzhugh | Dietitian, Registered | 1775 S. Basswood Trail, Laporte, IN 46350 | 2016-11-23 |
| 1568916971 | Total Renal Care, Inc. | Clinic/Center | 1406 E Lincolnway, Ste A, La Porte, IN 46350 | 2016-08-15 |
| 1083079008 | Irene Torres | Nurse Practitioner | 1407 Lincolnway, La Porte, IN 46350 | 2015-12-17 |
| 1124422910 | Becky Alwood-wallace | Occupational Therapist | 1203 Washington Street, Iu Health La Porte Hospital Wellness & Rehabilitation, La Porte, IN 46350 | 2014-10-22 |
| 1881001527 | Johnson Memorial Hospital | Skilled Nursing Facility | 3530 Monroe Street, La Porte, IN 46350 | 2014-07-15 |
| 1306268941 | Tiffany Anne Satterfield | Physical Therapy Assistant | 194 S 400 E, Laporte, IN 46350 | 2014-01-16 |
| 1801122239 | Mary Barbara Backer | Internal Medicine | 301 Willow Bend Dr, La Porte, IN 46350 | 2009-10-20 |
| Find all providers in zip 46350 | ||||
| Taxonomy Code | 363LP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639799935 | Krista Marie Van Baren | Nurse Practitioner | 414 Lincolnway, La Porte, IN 46350-3350 | 2020-04-16 |
| 1023232477 | Jennifer Campbell | Nurse Practitioner | 1509 State Street, La Porte, IN 46350-3429 | 2007-04-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043822844 | Kelsey M Knight | Nurse Practitioner | 705 Riley Hospital Dr Ste 1601, Indianapolis, IN 46202-5109 | 2020-08-21 |
| 1699306241 | Amber Barney | Nurse Practitioner | 3611 S Lafountain St, Kokomo, IN 46902 | 2020-02-03 |
| 1700420031 | Randi D Bragg | Nurse Practitioner | Marion Pediatrics, 1411w Bella Drive, Marion, IN 46953-5250 | 2019-10-30 |
| 1659923761 | Elizabeth Marie Bowen | Nurse Practitioner | 13914 Southeastern Pkwy Ste 300, Fishers, IN 46037-7126 | 2019-07-10 |
| 1912462664 | Mindy Kay Krsak | Nurse Practitioner | 3229 Broadway Ste 205, Gary, IN 46409-1038 | 2019-02-06 |
| 1497221154 | Christina Ownbey | Nurse Practitioner | 517 Ball Dr Unit 302, Hanover, IN 47243-9656 | 2018-10-22 |
| 1578056842 | Jenna Elizabeth Bednarski | Nurse Practitioner | 3741 Rome Dr Ste B, Lafayette, IN 47905-4490 | 2018-06-12 |
| 1427594696 | Alecia A Woody | Nurse Practitioner | 3400 Lafayette Rd, Suite 200, Shalom Health Care Center Inc, Indianapolis, IN 46222-1146 | 2017-01-12 |
| 1043688211 | Mary Hendrix | Nurse Practitioner | 3118 S Lafountain St # At, Kokomo, IN 46902-3710 | 2015-09-04 |
| 1487022810 | Hannah Renfrow | Nurse Practitioner | 1411 W Bella Drive, Marion, IN 46953 | 2015-09-02 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.