Provider Demographics
NPI:1083364640
Name:MANDEL, KAITLIN ELIZABETH CARTER (WHNP/CNM)
Entity Type:Individual
Prefix:MISS
First Name:KAITLIN
Middle Name:ELIZABETH CARTER
Last Name:MANDEL
Suffix:
Gender:F
Credentials:WHNP/CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 MARKET ST APT 366
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-7682
Mailing Address - Country:US
Mailing Address - Phone:858-722-6693
Mailing Address - Fax:
Practice Address - Street 1:7700 PARKWAY DR UNIT 39
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2025
Practice Address - Country:US
Practice Address - Phone:858-722-6693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-26
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104979831363LW0102X
CA367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife