Provider Demographics
NPI:1114511276
Name:MENDEZ, CHANELL SKYE (MSN, PMHNP - BC)
Entity Type:Individual
Prefix:MRS
First Name:CHANELL
Middle Name:SKYE
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:MSN, PMHNP - BC
Other - Prefix:
Other - First Name:CHANELL
Other - Middle Name:
Other - Last Name:O'ROURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:11435 APPALOOSA TRL
Mailing Address - Street 2:
Mailing Address - City:PINCKNEY
Mailing Address - State:MI
Mailing Address - Zip Code:48169-8937
Mailing Address - Country:US
Mailing Address - Phone:248-444-4828
Mailing Address - Fax:
Practice Address - Street 1:175 W B ST STE D
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4575
Practice Address - Country:US
Practice Address - Phone:248-444-4828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704345839163WP0808X
OR202114157NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health