Individual
EDITH MARIE MENDOZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2485 E SOUTHLAKE BLVD STE 100, SOUTHLAKE, TX 76092-6687
(817) 873-0590
(817) 873-0591
Mailing address
2485 E SOUTHLAKE BLVD STE 100, SOUTHLAKE, TX 76092-6687
(817) 873-0590
(817) 873-0591
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP1088173
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
630874
RN
TX
01
—
AP1088173
APRN
TX
Enumeration date
07/21/2022
Last updated
07/21/2022
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