Provider Demographics
NPI:1760880017
Name:MENDEZ, CARMEN L (FNP)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:L
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 STEVENS AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2543
Mailing Address - Country:US
Mailing Address - Phone:646-207-9934
Mailing Address - Fax:
Practice Address - Street 1:153 STEVENS AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2543
Practice Address - Country:US
Practice Address - Phone:646-207-9934
Practice Address - Fax:914-668-0629
Is Sole Proprietor?:No
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338574-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily