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General NPI Number Information
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NPI Number | 1952000226
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Entity Type | Organization
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Legal Business Name | GLOW LAND COMPANY, LLC
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Dates
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Enumeration Date | 02/27/2023
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Last Update Date | 02/27/2023
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Provider Practice Location Address
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Address Line | 1618 S BUCKNER BLVD
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City | DALLAS
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State | TX
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Zip | 75217-1707
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Country | US
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Telephone | 469-248-0090
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Fax | 214-930-1084
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Provider Business Mailing Address
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Address Line | 1618 S BUCKNER BLVD
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City | DALLAS
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State | TX
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Zip | 75217-1707
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Country | US
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Telephone | 469-248-0090
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Fax | 214-930-1084
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | YUNIER MENDEZ PUPO
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Credential |
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Telephone | 469-248-0090
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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 |
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License Number State |
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