Healthcare Provider Details

I. General information

NPI: 1902199045
Provider Name (Legal Business Name): TERRI LYNNE MENDOZA NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 FRANKLIN ST
DENVER CO
80218-1126
US

IV. Provider business mailing address

1835 FRANKLIN ST
DENVER CO
80218-1126
US

V. Phone/Fax

Practice location:
  • Phone: 303-837-7290
  • Fax:
Mailing address:
  • Phone: 303-837-7290
  • Fax: 303-866-8469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number113350
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: