Provider Demographics
NPI:1457503138
Name:HOUSE, MENDEE LEN
Entity Type:Individual
Prefix:
First Name:MENDEE
Middle Name:LEN
Last Name:HOUSE
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 1:419 N NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:WATONGA
Mailing Address - State:OK
Mailing Address - Zip Code:73772-3024
Mailing Address - Country:US
Mailing Address - Phone:405-922-0078
Mailing Address - Fax:
Practice Address - Street 1:10020 MAHLER PL
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-3312
Practice Address - Country:US
Practice Address - Phone:405-206-2077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program