Provider Demographics
NPI:1396401378
Name:DODSON-MENDENHALL, NATALIE KAI (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:KAI
Last Name:DODSON-MENDENHALL
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 281
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-0281
Mailing Address - Country:US
Mailing Address - Phone:805-710-9955
Mailing Address - Fax:
Practice Address - Street 1:625 CRYSTAL WAY
Practice Address - Street 2:
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444-9662
Practice Address - Country:US
Practice Address - Phone:805-710-9955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-13
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-132893163WL0100X
CA95046552163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty