MEDICARE: GLENDA MARIE REDEEMER RN

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	163W00000X	Registered Nurse	660833	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932125598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENDA MARIE REDEEMER RN

Provider Business Mailing Address
First Line	:	1101 S MAIN ST
Second Line	:	STE 1206
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4802
Country	:	US
Telephone Number	:	817-321-4710
Fax Number	:	817-321-5338

Provider Business Practice Location Address
First Line	:	1101 S MAIN ST
Second Line	:	STE 1206
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4802
Country	:	US
Telephone Number	:	817-321-4710
Fax Number	:	817-321-5338

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

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	10/10/2016

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