Provider Demographics
NPI:1427871243
Name:MENDEZ, RUTH SCARLET (NURSE PRATICIONER)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:SCARLET
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:NURSE PRATICIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 CHARTER OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-5109
Mailing Address - Country:US
Mailing Address - Phone:631-464-6009
Mailing Address - Fax:
Practice Address - Street 1:128 CHARTER OAKS AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-5109
Practice Address - Country:US
Practice Address - Phone:631-464-6009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312107363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology