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Individual

SUSAN PROUT MENDENILLA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
189 GOLD CREEK DR, LAKE GEORGE, CO 80827-9009
(719) 748-5079
Mailing address
189 GOLD CREEK DR, LAKE GEORGE, CO 80827-9009
(719) 748-5079

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN.0121121
CO

Other

Enumeration date
09/03/2013
Last updated
09/03/2013
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