Provider Demographics
NPI:1316195126
Name:MENDOZA, MAUREEN (MSN, APN)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MSN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 JUSTINE LN
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4475
Mailing Address - Country:US
Mailing Address - Phone:609-748-0479
Mailing Address - Fax:
Practice Address - Street 1:2626 TILTON RD
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-1829
Practice Address - Country:US
Practice Address - Phone:609-568-5000
Practice Address - Fax:609-568-5015
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ001696363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health