Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 441738 | TX |
NPI | 1003898529 |
---|---|
Provider Name | Mrs. Glenda Sue Patredis |
First Address | Dallas, TX 75266-0599 |
Second Address | Dallas, TX 75235-7708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 05/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
138982701 | (05) | TX |
138982702 | (05) | TX |
138982703 | (05) | TX |
138982704 | (05) | TX |
138982707 | (05) | TX |
138982708 | (05) | TX |
138982710 | (05) | TX |
138982713 | (05) | TX |
138982715 | (05) | TX |
138982716 | (05) | TX |
S83338 | (02) | TX |