Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | GAA-NP000074 | GA |
N | 363LA2200X | Nurse Practitioner - Adult Health | GAA-NP000074 | GA |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | GAA-NP000074 | GA |
N | 363LG0600X | Nurse Practitioner - Gerontology | GAA-NP000074 | GA |
NPI | 1174199145 |
---|---|
Provider Name | Mrs. Teresa Ann Mendez |
First Address | Woodstock, GA 30188-2148 |
Second Address | Marietta, GA 30060-1101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2021 |
Last Update Date | 01/06/2021 |