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Individual

GLYNDA MAE DALLAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CNP

Contact information

Practice address
2000 W 21ST ST, #A-1, CLOVIS, NM 88101-4087
(575) 762-8055
(575) 763-3351
Mailing address
2000 W 21ST ST, SUITE A-1, CLOVIS, NM 88101-4087
(575) 762-8055
(575) 763-3351

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R47073
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
39038
NM
Enumeration date
05/17/2006
Last updated
02/29/2012
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