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Contact Information

GLYNDA M DALLAS, CNP
2000 W 21ST ST
#A-1
CLOVIS, NM88101-4087
 Phone: 575-762-8055
 Fax: 575-763-3351
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nurse Practitioner

363L00000X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for GLYNDA M DALLAS · (Female)

NPI # 1255383261
Status Active
Credentials CNP (Certified Nurse Practitioner)
Entity Individual
Enumeration date 05/17/2006
Last updated 02/29/2012 - About 14 years ago
Sole proprietor 1 No
Identifiers
  • NM License # R47073
  • NM Medicaid 39038
Hospital affiliation(s)
  • PLAINS REGIONAL MEDICAL CENTER CLOVIS - (Acute Care)
    2100 N MARTIN LUTHER KING, JR, BLVD
    CLOVIS, NM 88101
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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