Mendoza, Edith Marie
Mendoza, Edith Marie is an individual health care provider with primary practice located at 2485 E Southlake Blvd Ste 100 , Southlake TX 76092-6687. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, which is considered as her primary health care specialty. Mendoza, Edith Marie can be contacted via phone (817) 873-0590.Contact Information
Primary practice address
2485 E Southlake Blvd Ste 100
Southlake TX 76092-6687
Phone: (817) 873-0590
Fax: (817) 873-0591
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health | 363LP0808X | AP1088173 | Texas |
Profile Details
| NPI number | 1720713969 |
|---|---|
| LBN Legal business name | Mendoza, Edith Marie |
| Credentials | Nurse Practitioner (NP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 21st, 2022 |
| Last updated | Jul 21st, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1720713969 | NPPES |
| Texas | Other | AP1088173 | APRN |
| Texas | Other | 630874 | APRN |
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