Provider Demographics
NPI:1891768115
Name:MENCEL, PATRICIA (APRN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MENCEL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W MONROE ST STE 1200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-2420
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:773-866-8014
Practice Address - Street 1:3250 FREEDOM DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-2817
Practice Address - Country:US
Practice Address - Phone:704-709-6009
Practice Address - Fax:704-899-0470
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001852363L00000X
NC5009719363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP000057594OtherRAILROAD MEDICARE
CT004188662Medicaid
S61703Medicare UPIN
CT004188662Medicaid