Individual
MR. ROGER GEORGE MENDENHALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
805 LINDA DR, ATLANTIC, IA 50022-2728
(712) 243-4563
(712) 243-4563
Mailing address
805 LINDA DR, PO BOX 601, ATLANTIC, IA 50022-2728
(712) 243-4563
(712) 243-4563
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
D047194
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0061069
—
IA
Enumeration date
07/10/2006
Last updated
07/09/2007
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