MEDICARE: MS. GLYNDA KEVIN SCHMELZLA RN, RNFA

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	163WR0006X	Registered Nurse First Assistant	RN041640	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	AW6720	OTHER	HEALTH NET
2	6030178	OTHER	CIGNA
3	AZ0162980	OTHER	BLUECROSS/BLUESHIELD
4	3959246	OTHER	AETNA
5	X03135	OTHER	AZ PHYSICIANS IPA

General Provider Information

NPI Number	:	1609961036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GLYNDA KEVIN SCHMELZLA RN, RNFA

Provider Business Mailing Address
First Line	:	1901 MILLER RD
Second Line	:
City	:	ROWLETT
State	:	TX
Zip	:	75088-5604
Country	:	US
Telephone Number	:	214-227-2457
Fax Number	:	214-764-0880

Provider Business Practice Location Address
First Line	:	6917 E CALLE CENTURI
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-5424
Country	:	US
Telephone Number	:	520-392-8474
Fax Number	:	520-392-8474

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	03/18/2019

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