Mendalose Ortega Harris, RN

Primary specialty

Community Health Registered NurseTaxonomy code 163WC1500X

License

041257023 Issued in IL

Practice address

300 East Hospital Road
Dwight David Eisenhower Army Medical Center
Fort Gordon, GA 30905-5650

Phone

(706) 787-1193

NPI assigned

Jan 5, 2010

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1262649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428969600000",
    "number": "1093045684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38701 38TH ST",
            "address_2": "PREVENTATIVE MEDICINE BUILDING",
            "city": "FORT GORDON",
            "state": "GA",
            "postal_code": "309055650",
            "telephone_number": "706-787-1193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 EAST HOSPITAL ROAD",
            "address_2": "DWIGHT DAVID EISENHOWER ARMY MEDICAL CENTER",
            "city": "FORT GORDON",
            "state": "GA",
            "postal_code": "309055650",
            "telephone_number": "706-787-1193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "MENDALOSE",
        "middle_name": "ORTEGA",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-01-05",
        "last_updated": "2015-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Community Health",
            "state": "IL",
            "license": "041257023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARMY PUBLIC HEALTH NURSE-MILITARY PROVIDER",
            "identifier": "041257023",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Larry Jay Hanson, DDS
• Waqas Haq, MD
• Andrew Harley
• Mahkeba Unique Harper
• Margaret M Harris, PA-C
• Eileen L Hartman, RDH
• Jamie Hartseil
• Lisa Ann Harwell
• Charles Lee Hatley, DMD
• Esther Hatzigeorgiou

• Community Health Registered Nurse in Fort Gordon, GA
• Providers in Fort Gordon, GA by specialty
• Community Health Registered Nurse in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.