Provider Demographics
NPI:1467295113
Name:MENDEZ, IYNEZ
Entity type:Individual
Prefix:
First Name:IYNEZ
Middle Name:
Last Name:MENDEZ
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 1:6312 BROWNING RD APT 318
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-1578
Mailing Address - Country:US
Mailing Address - Phone:856-655-9550
Mailing Address - Fax:
Practice Address - Street 1:6312 BROWNING RD
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-1564
Practice Address - Country:US
Practice Address - Phone:856-655-9550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR18113900363LF0000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily