Provider Demographics
NPI:1063129898
Name:MENDEZ, WILBER L (PMHNP)
Entity type:Individual
Prefix:
First Name:WILBER
Middle Name:L
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 778
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CO
Mailing Address - Zip Code:81620-0778
Mailing Address - Country:US
Mailing Address - Phone:970-471-9923
Mailing Address - Fax:
Practice Address - Street 1:82 E BEAVER CREEK BLVD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CO
Practice Address - Zip Code:81620-5889
Practice Address - Country:US
Practice Address - Phone:970-445-2821
Practice Address - Fax:970-343-7882
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0998425-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health