MEDICARE: MEKENZIE MENDOZA CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WA2000X	Administrator Registered Nurse	28259659A	IN
2	367A00000X	Advanced Practice Midwife	09000488A	IN
3	363LW0102X	Women's Health Nurse Practitioner	71016250A	IN

General Provider Information

NPI Number	:	1265267785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEKENZIE MENDOZA CNM

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11725 N ILLINOIS ST
Second Line	:	STE 245
City	:	CARMEL
State	:	IN
Zip	:	46032-3011
Country	:	US
Telephone Number	:	317-249-2703
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2024
Last Update Date	:	04/08/2026

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Directions to “ MEKENZIE MENDOZA CNM” Practice Location

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