MEDICARE: GRACE GLENDA BALDERAS A.P.R.N. B.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364S00000X	Clinical Nurse Specialist	AP114274	TX
2	363L00000X	Nurse Practitioner	AP114274	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	289693YLLW	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01523495	OTHER	TX	RAILROAD MCR
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134109366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE GLENDA BALDERAS A.P.R.N. B.C.

Provider Business Mailing Address
First Line	:	6800 W IH 10
Second Line	:	SUITE 350
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-2038
Country	:	US
Telephone Number	:	210-692-1414
Fax Number	:	210-546-0358

Provider Business Practice Location Address
First Line	:	6800 W IH 10
Second Line	:	SUITE 350
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-2038
Country	:	US
Telephone Number	:	210-692-1414
Fax Number	:	210-546-0358

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	01/28/2022

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Directions to “ GRACE GLENDA BALDERAS A.P.R.N. B.C.” Practice Location

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