| Doctor Name: | MENDALOSE ORTEGA HARRIS |
| NPI Number: | 1093045684 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | 041257023 |
| Business Practice Address: | 300 East Hospital Road Dwight David Eisenhower Army Medical Center Fort Gordon, GA - 309055650 |
| Business Phone Number: | 7067871193 |
| Business Fax Number: | |
| Mailing Address: | 38701 38th St, Preventative Medicine Building FORT GORDON |
| State: | GA |
| Postal Code: | 309055650 |
| Phone Number: | 7067871193 |
| Fax Number: | |
| NPI Enumeration Date: | 01/05/2010 |
| NPI Last Update Date: | 04/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WC1500X |
| License Number: | 041257023 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |