Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0200X | Radiology | 32550 | CA |
N | 213ER0200X | Radiology | 32550 | CA |
Y | 111NR0200X | Radiology | 5903 | MN |
Y | 213ER0200X | Radiology | 5903 | MN |
NPI | 1437517521 |
---|---|
Provider Name | Dr. Heidi Lee Mendenhall |
First Address | Osseo, MN 55369-1227 |
Second Address | Osseo, MN 55369-1227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2016 |
Last Update Date | 03/02/2016 |