Provider Demographics
NPI:1699814814
Name:MENTOR, MARGANN (CNM)
Entity Type:Individual
Prefix:
First Name:MARGANN
Middle Name:
Last Name:MENTOR
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1779 DOMINICAN WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1526
Mailing Address - Country:US
Mailing Address - Phone:831-479-4966
Mailing Address - Fax:831-479-4967
Practice Address - Street 1:1779 DOMINICAN WAY
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1526
Practice Address - Country:US
Practice Address - Phone:831-479-4966
Practice Address - Fax:831-479-4967
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANMW712367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife