Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 12451-NP | OH |
NPI | 1043599202 |
---|---|
Provider Name | Laura I Mendoza |
First Address | Norwalk, OH 44857-2712 |
Second Address | Norwalk, OH 44857-2712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2011 |
Last Update Date | 06/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0053752 | (05) | OH |