Provider Demographics
NPI:1831906890
Name:MENDOZA, MADELINE ROMANELLA (CRNP)
Entity type:Individual
Prefix:MISS
First Name:MADELINE
Middle Name:ROMANELLA
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1211 S EATON ST UNIT 4038
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4398
Mailing Address - Country:US
Mailing Address - Phone:732-470-6623
Mailing Address - Fax:
Practice Address - Street 1:5415 OLD COURT RD STE 2
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-5170
Practice Address - Country:US
Practice Address - Phone:410-602-7782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC007065363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily