Provider Demographics
NPI:1912964230
Name:UNITED STATES ARMY NURSE CORPS
Entity Type:Organization
Organization Name:UNITED STATES ARMY NURSE CORPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAJ, AN
Authorized Official - Prefix:
Authorized Official - First Name:MENDALOSE
Authorized Official - Middle Name:O
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:326-544-5044
Mailing Address - Street 1:SHAPE HCF UNIT 21414 BOX 169
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09705
Mailing Address - Country:BE
Mailing Address - Phone:326-544-5044
Mailing Address - Fax:326-544-5953
Practice Address - Street 1:SHAPE HCF UNIT 21414 BOX 169
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09705
Practice Address - Country:BE
Practice Address - Phone:326-544-5044
Practice Address - Fax:326-544-5953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health