Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 21776 | SC |
NPI | 1386137685 |
---|---|
Provider Name | Kiira Kathryn Mendenhall |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2018 |
Last Update Date | 17/07/2018 |