Provider Demographics
NPI:1023263993
Name:MORTIMER, GLENDA SHARLENE (NP-C)
Entity type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:SHARLENE
Last Name:MORTIMER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 RIDGEMONT DR # 206
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-2712
Mailing Address - Country:US
Mailing Address - Phone:325-333-0898
Mailing Address - Fax:
Practice Address - Street 1:830 NE LOOP 410
Practice Address - Street 2:GODWIN CORPORATION SUITE 211
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209
Practice Address - Country:US
Practice Address - Phone:877-446-3946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX244153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily