Provider Demographics
NPI:1083364640
Name:MANDEL, KAITLIN ELIZABETH CARTER (WHNP/CNM)
Entity type:Individual
Prefix:MISS
First Name:KAITLIN
Middle Name:ELIZABETH CARTER
Last Name:MANDEL
Suffix:
Gender:F
Credentials:WHNP/CNM
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Other - First Name:
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Mailing Address - Street 1:7700 PARKWAY DR UNIT 39
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-2025
Mailing Address - Country:US
Mailing Address - Phone:858-722-6693
Mailing Address - Fax:
Practice Address - Street 1:5525 GROSSMONT CENTER DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3009
Practice Address - Country:US
Practice Address - Phone:858-499-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-26
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA367A00000X
CA104979831363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife