Individual
MENDALOSE ORTEGA HARRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
300 EAST HOSPITAL ROAD, DWIGHT DAVID EISENHOWER ARMY MEDICAL CENTER, FORT GORDON, GA 30905-5650
(706) 787-1193
Mailing address
38701 38TH ST, PREVENTATIVE MEDICINE BUILDING, FORT GORDON, GA 30905-5650
(706) 787-1193
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
041257023
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041257023
ARMY PUBLIC HEALTH NURSE-MILITARY PROVIDER
IL
Enumeration date
01/05/2010
Last updated
04/14/2015
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