Provider Demographics
NPI:1386218014
Name:MENDEZ, KRYSTLE G
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:G
Last Name:MENDEZ
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 1:28863 OREGON RD APT G70
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-3565
Mailing Address - Country:US
Mailing Address - Phone:219-214-7446
Mailing Address - Fax:
Practice Address - Street 1:28863 OREGON RD APT G70
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-3565
Practice Address - Country:US
Practice Address - Phone:219-214-7446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant