Provider Demographics
NPI:1134995343
Name:MENDENHALL, LORENA LEE
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:LEE
Last Name:MENDENHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5377 FLOTRON DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-3865
Mailing Address - Country:US
Mailing Address - Phone:614-619-0540
Mailing Address - Fax:
Practice Address - Street 1:4269 AMSTON DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-5088
Practice Address - Country:US
Practice Address - Phone:614-619-0540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide