Provider Demographics
NPI:1609292614
Name:MENDOZA-MONTOYA, IRMA (NP)
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:
Last Name:MENDOZA-MONTOYA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 NW 11TH ST STE M201
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-6941
Mailing Address - Country:US
Mailing Address - Phone:541-289-4118
Mailing Address - Fax:541-667-3484
Practice Address - Street 1:675 N 5TH ST STE 200
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-2875
Practice Address - Country:US
Practice Address - Phone:541-451-6282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-14
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN107615163W00000X
OR201900272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse