Provider Demographics
NPI:1255677365
Name:MENDEZ, MEGAN KAYLE (LMP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:KAYLE
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 BICKFORD AVE
Mailing Address - Street 2:APT # B309
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-1771
Mailing Address - Country:US
Mailing Address - Phone:425-344-5535
Mailing Address - Fax:
Practice Address - Street 1:1800 BICKFORD AVE
Practice Address - Street 2:APT # B309
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-1771
Practice Address - Country:US
Practice Address - Phone:425-344-5535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60302862171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor