1871043729 NPI number — CRYSTAL MENDONSA DNP

Table of content: CRYSTAL MENDONSA DNP (NPI 1871043729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871043729 NPI number — CRYSTAL MENDONSA DNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENDONSA
Provider First Name:
CRYSTAL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871043729
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80 BAYLIES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAUNTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02780-2743
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
774-259-6013
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
191 BEDFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FALL RIVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02720-3050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-235-5445
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X , with the licence number:  RN265573 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)