Provider Demographics
NPI:1881345569
Name:MENDEZ, KATHRYN MARGARET (NP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARGARET
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 PALM ST
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218-2028
Mailing Address - Country:US
Mailing Address - Phone:716-435-5777
Mailing Address - Fax:
Practice Address - Street 1:237 LINWOOD AVE FL 1
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2009
Practice Address - Country:US
Practice Address - Phone:716-884-8018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349039363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner