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NPI Code Detail

MEDICARE: HANNAH ELIZABETH MENDEZ PA-S

MEDICARE: HANNAH ELIZABETH MENDEZ PA-S
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1912513417
Entity Type Code : Individual
Provider Name (Legal Business Name) : HANNAH ELIZABETH MENDEZ PA-S
Provider Business Mailing Address
First Line : 2172 GROVELAND WAY
Second Line :
City : SHAKOPEE
State : MN
Zip : 55379-4339
Country : US
Telephone Number : 612-250-6111
Fax Number :
Provider Business Practice Location Address
First Line : 1320 W LOMBARD ST
Second Line :
City : DAVENPORT
State : IA
Zip : 52804-2029
Country : US
Telephone Number : 563-333-6069
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2020
Last Update Date : 09/20/2020

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