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NPI Code Detail

MEDICARE: MATTHEW MENDILLO APRN,FNP-C

MEDICARE: MATTHEW MENDILLO APRN,FNP-C
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
1363LF0000XFamily Nurse PractitionerSP021250PA
2363LF0000XFamily Nurse Practitioner5023866NC
3363LF0000XFamily Nurse PractitionerLG-0013457DE
4363LF0000XFamily Nurse PractitionerAPRN11037015FL
5363LF0000XFamily Nurse PractitionerAPRN.CNP.0036815OH
6363LF0000XFamily Nurse Practitioner41459TN

General Provider Information

NPI Number : 1467090415
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW MENDILLO APRN,FNP-C
Provider Business Mailing Address
First Line : PO BOX 211699
Second Line :
City : EAGAN
State : MN
Zip : 55121-3699
Country : US
Telephone Number : 866-849-0692
Fax Number : 888-973-8821
Provider Business Practice Location Address
First Line : 100 S JUNIPER ST FL 3
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19107-1316
Country : US
Telephone Number : 866-849-0692
Fax Number : 888-973-8821
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2019
Last Update Date : 03/16/2026

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