Healthcare Provider Details

I. General information

NPI: 1164032256
Provider Name (Legal Business Name): MENDENHALL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 RYLAND ST
RENO NV
89502-1659
US

IV. Provider business mailing address

6017 W VALLEY VIEW DR
HIGHLAND UT
84003-3654
US

V. Phone/Fax

Practice location:
  • Phone: 801-652-7599
  • Fax:
Mailing address:
  • Phone: 801-652-7599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT MENDENHALL
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 801-652-7599