Provider Demographics
NPI:1407325814
Name:MENDOZA, VANESSA L (LVN)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:L
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8714 WOOD GLEN DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-4855
Mailing Address - Country:US
Mailing Address - Phone:469-274-6033
Mailing Address - Fax:
Practice Address - Street 1:8714 WOOD GLEN DR
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4855
Practice Address - Country:US
Practice Address - Phone:469-274-6033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314241164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse