Individual
NICOLE RAE MENDOZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, MSN, FNP
Contact information
Practice address
19 MYRTLE ST, MEDFORD, OR 97504-7337
(542) 773-3863
Mailing address
329 S IVY ST, MEDFORD, OR 97501-3174
(541) 897-7383
(541) 320-9023
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
201508266NP-PP
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
201508266NP-PP
OR
363LP2300X
Primary Care Nurse Practitioner
Primary
201508266NP-PP
OR
Other
Enumeration date
02/01/2016
Last updated
02/12/2021
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