Provider Demographics
NPI:1073327607
Name:MENTOWAH, LYDIA U
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:U
Last Name:MENTOWAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8194 CLEADIS AVE
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-3320
Mailing Address - Country:US
Mailing Address - Phone:651-895-9823
Mailing Address - Fax:
Practice Address - Street 1:8194 CLEADIS AVE
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-3320
Practice Address - Country:US
Practice Address - Phone:651-895-9823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide