Provider Demographics
NPI:1609961036
Name:SCHMELZLA, GLYNDA KEVIN (RN, RNFA)
Entity type:Individual
Prefix:MS
First Name:GLYNDA
Middle Name:KEVIN
Last Name:SCHMELZLA
Suffix:
Gender:F
Credentials:RN, RNFA
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:SCHMELZLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RNFA
Mailing Address - Street 1:1901 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-5604
Mailing Address - Country:US
Mailing Address - Phone:214-227-2457
Mailing Address - Fax:214-764-0880
Practice Address - Street 1:6917 E CALLE CENTURI
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-5424
Practice Address - Country:US
Practice Address - Phone:520-392-8474
Practice Address - Fax:520-392-8474
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN041640163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AW6720OtherHEALTH NET
6030178OtherCIGNA
AZ0162980OtherBLUECROSS/BLUESHIELD
3959246OtherAETNA
X03135OtherAZ PHYSICIANS IPA