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NPI Code Detail

MEDICARE: SUE MENDEZ NP

MEDICARE: SUE MENDEZ NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner041206751/209002498IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1445636YKRDOTHERCOMEDICARE NUMBER

General Provider Information

NPI Number : 1114004553
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUE MENDEZ NP
Provider Business Mailing Address
First Line : 3205 N ACADEMY BLVD
Second Line : 130
City : COLORADO SPRINGS
State : CO
Zip : 80917-5147
Country : US
Telephone Number : 719-632-5700
Fax Number :
Provider Business Practice Location Address
First Line : 4863 N NEVADA AVE
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-3951
Country : US
Telephone Number : 719-632-5700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 11/12/2015

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Directions to “ SUE MENDEZ NP” Practice Location

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