Provider Demographics
NPI:1912624156
Name:MENDEZ, ILEY MAE (APRN)
Entity Type:Individual
Prefix:
First Name:ILEY
Middle Name:MAE
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 S CESAR CHAVEZ BLVD APT 934
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-5822
Mailing Address - Country:US
Mailing Address - Phone:405-694-0911
Mailing Address - Fax:
Practice Address - Street 1:1925 W JOHN CARPENTER FWY
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3222
Practice Address - Country:US
Practice Address - Phone:972-292-7158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1096845363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health