MEDICARE: MRS. EVELYN GONZALES MENDOZA R.N.

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
1	163W00000X	Registered Nurse	3553511	NY

General Provider Information

NPI Number	:	1679916662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EVELYN GONZALES MENDOZA R.N.

Provider Business Mailing Address
First Line	:	1824 HANOVER ST
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-4652
Country	:	US
Telephone Number	:	914-299-4337
Fax Number	:

Provider Business Practice Location Address
First Line	:	1824 HANOVER ST
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-4652
Country	:	US
Telephone Number	:	914-299-4337
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2013
Last Update Date	:	04/10/2013

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