Basic Information
| Provider Information | |||||||||
| NPI: | 1043631864 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLADDEN | ||||||||
| FirstName: | CAMILLE | ||||||||
| MiddleName: | JOYCE | ||||||||
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| Credential: | RN, BSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18 TOWER ST APT 2 | ||||||||
| Address2: | |||||||||
| City: | JAMAICA PLAIN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021303705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175227376 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 780 ALBANY ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8576541000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2013 | ||||||||
| LastUpdateDate: | 01/06/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN260094 | MA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.