Harris, Mendalose Ortega

Harris, Mendalose Ortega is an sole proprietor health care provider with primary practice located at 300 East Hospital Road Dwight David Eisenhower Army Medical Center, Fort Gordon GA 30905-5650. She recently has only one registered license in Nursing Service Providers / Community Health, which is considered as her primary health care specialty. Harris, Mendalose Ortega can be contacted via phone (706) 787-1193.

Contact Information

Primary practice address
300 East Hospital Road Dwight David Eisenhower Army Medical Center Fort Gordon GA 30905-5650
Phone: (706) 787-1193
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Community Health 163WC1500X 041257023 Illinois

Profile Details

NPI number 1093045684
LBN Legal business name Harris, Mendalose Ortega
Credentials Registered Nurse (RN)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 5th, 2010
Last updated Apr 14th, 2015 - about 10 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1093045684 NPPES
Illinois Other 041257023 ARMY PUBLIC HEALTH NURSE-MILITARY PROVIDER

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