MEDICARE: GLENDA CERVANTES

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	171R00000X	Interpreter

General Provider Information

NPI Number	:	1780078949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENDA CERVANTES

Provider Business Mailing Address
First Line	:	1324 S ELLSWORTH AVE
Second Line	:
City	:	MARSHALL
State	:	MO
Zip	:	65340-3059
Country	:	US
Telephone Number	:	660-815-5388
Fax Number	:

Provider Business Practice Location Address
First Line	:	1324 S ELLSWORT AVE
Second Line	:
City	:	MARSHALL
State	:	MO
Zip	:	65340
Country	:	US
Telephone Number	:	660-815-5388
Fax Number	:

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

Provider Enumeration Date	:	03/26/2015
Last Update Date	:	03/26/2015

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Directions to “ GLENDA CERVANTES ” Practice Location

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