Dallas, Glynda Mae
Dallas, Glynda Mae is an individual health care provider with primary practice located at 2000 W 21St St #A-1, Clovis NM 88101-4087. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Dallas, Glynda Mae can be contacted via phone (575) 762-8055.Contact Information
Primary practice address
2000 W 21St St #A-1
Clovis NM 88101-4087
Phone: (575) 762-8055
Fax: (575) 763-3351
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner | 363L00000X | R47073 | New Mexico |
Profile Details
| NPI number | 1255383261 |
|---|---|
| LBN Legal business name | Dallas, Glynda Mae |
| Credentials | Certified Nurse Practitioner (CNP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 17th, 2006 |
| Last updated | Feb 29th, 2012 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1255383261 | NPPES |
| New Mexico | MEDICAID | 39038 |
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