Healthcare Provider Details

I. General information

NPI: 1619626546
Provider Name (Legal Business Name): GLORIA JEAN ARMSTRONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3032 LITTLE BROOK LN APT 1062
ARLINGTON TX
76010-0101
US

IV. Provider business mailing address

3032 LITTLE BROOK LN APT 1062
ARLINGTON TX
76010-0101
US

V. Phone/Fax

Practice location:
  • Phone: 214-874-5996
  • Fax:
Mailing address:
  • Phone: 214-874-5996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number1118906
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: