Provider Demographics
NPI:1043649866
Name:STEGALL, GLENDA NELL (RN)
Entity Type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:NELL
Last Name:STEGALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 EDEN DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-4104
Mailing Address - Country:US
Mailing Address - Phone:903-261-4122
Mailing Address - Fax:903-753-1056
Practice Address - Street 1:1409 EDEN DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-4104
Practice Address - Country:US
Practice Address - Phone:903-261-4122
Practice Address - Fax:903-753-1056
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX655652163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice