Provider Demographics
NPI:1003671868
Name:MENDOZA, KARIN CHRISTINE (MSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:KARIN
Middle Name:CHRISTINE
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:KARIN
Other - Middle Name:CHRISTINE
Other - Last Name:LORENZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4498 IRONHORSE WAY
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5457
Mailing Address - Country:US
Mailing Address - Phone:540-841-9793
Mailing Address - Fax:
Practice Address - Street 1:6102 TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5940
Practice Address - Country:US
Practice Address - Phone:270-461-0568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001225453163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health