Healthcare Provider Details

I. General information

NPI: 1093541195
Provider Name (Legal Business Name): MARIA ANN MENDRINOS CHAVOUS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA ANN MENDRINOS

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DRIVE MEADE HALL GROUND FLOOR
WINSTON SALEM NC
27157-4331
US

IV. Provider business mailing address

2123 ROCKFORD STREET SUITE 300 #1018
MOUNT AIRY NC
27030
US

V. Phone/Fax

Practice location:
  • Phone: 833-832-5669
  • Fax:
Mailing address:
  • Phone: 203-836-1988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5020835
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number5020835
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: