Provider Demographics
NPI:1306731039
Name:MENCHAVEZ, EDZIEL ZEPEDA (RN)
Entity type:Individual
Prefix:
First Name:EDZIEL
Middle Name:ZEPEDA
Last Name:MENCHAVEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 LORRAINE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1953
Mailing Address - Country:US
Mailing Address - Phone:347-621-8673
Mailing Address - Fax:
Practice Address - Street 1:195 LORRAINE AVE APT 1
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1953
Practice Address - Country:US
Practice Address - Phone:347-621-8673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR15888000163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse