Healthcare Provider Details

I. General information

NPI: 1497314165
Provider Name (Legal Business Name): PAULA LEE MENDENHALL INTERMEDIATE EMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 W WENTWORTH ST
NEWCASTLE WY
82701-2838
US

IV. Provider business mailing address

PO BOX 492
NEWCASTLE WY
82701-0492
US

V. Phone/Fax

Practice location:
  • Phone: 307-746-2800
  • Fax:
Mailing address:
  • Phone: 307-746-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number101219
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number101219
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: