Provider Demographics
NPI:1295022796
Name:MENDIOLA, MICHAELYN DAWN
Entity Type:Individual
Prefix:MRS
First Name:MICHAELYN
Middle Name:DAWN
Last Name:MENDIOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 S OLIE AVE
Mailing Address - Street 2:UNIT 5
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-9359
Mailing Address - Country:US
Mailing Address - Phone:405-616-2442
Mailing Address - Fax:
Practice Address - Street 1:8801 S OLIE AVE
Practice Address - Street 2:UNIT 5
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9359
Practice Address - Country:US
Practice Address - Phone:405-616-2442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health