Provider Demographics
NPI:1023428356
Name:MENDENHALL, MARY KATHLEEN (RN)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:KATHLEEN
Last Name:MENDENHALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:640 S MISSION ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-3050
Mailing Address - Country:US
Mailing Address - Phone:509-662-6761
Mailing Address - Fax:509-888-5537
Practice Address - Street 1:640 S MISSION ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-3050
Practice Address - Country:US
Practice Address - Phone:509-662-6761
Practice Address - Fax:509-888-5537
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN 60206116163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARN 60206116OtherWASHINGTON STATE DEPARTMENT OF HEALTH (NURSING LICENSE)