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General NPI Number Information
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NPI Number | 1831906890
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Entity Type | Individual
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Provider Name | MADELINE ROMANELLA MENDOZA CRNP
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Gender | Female
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 5415 OLD COURT RD STE 2
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-5170
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Country | US
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Telephone | 410-602-7782
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Fax |
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Provider Business Mailing Address
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Address Line | 1211 S EATON ST UNIT 4038
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City | BALTIMORE
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State | MD
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Zip | 21224-4398
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Country | US
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Telephone | 732-470-6623
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AC007065
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License Number State | MD
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