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General NPI Number Information
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NPI Number | 1023263993
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Entity Type | Individual
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Provider Name | GLENDA SHARLENE MORTIMER NP-C
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Gender | Female
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Dates
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Enumeration Date | 11/19/2008
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Last Update Date | 03/06/2014
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Provider Practice Location Address
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Address Line | 830 NE LOOP 410 GODWIN CORPORATION SUITE 211
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City | SAN ANTONIO
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State | TX
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Zip | 78209
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Country | US
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Telephone | 877-446-3946
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Fax |
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Provider Business Mailing Address
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Address Line | 4250 RIDGEMONT DR # 206
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City | ABILENE
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State | TX
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Zip | 79606-2712
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Country | US
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Telephone | 325-333-0898
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 244153
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License Number State | TX
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