Provider Demographics
NPI:1497314165
Name:MENDENHALL, PAULA LEE (INTERMEDIATE EMT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:LEE
Last Name:MENDENHALL
Suffix:
Gender:F
Credentials:INTERMEDIATE EMT
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 492
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WY
Mailing Address - Zip Code:82701-0492
Mailing Address - Country:US
Mailing Address - Phone:307-746-2800
Mailing Address - Fax:
Practice Address - Street 1:7 W WENTWORTH ST
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WY
Practice Address - Zip Code:82701-2838
Practice Address - Country:US
Practice Address - Phone:307-746-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY101219207PE0004X, 146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services