Provider Demographics
NPI:1528658143
Name:MENDOZA, MARK NOWELL (FNP)
Entity type:Individual
Prefix:MR
First Name:MARK NOWELL
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 RHINELANDER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-3402
Mailing Address - Country:US
Mailing Address - Phone:347-944-7556
Mailing Address - Fax:
Practice Address - Street 1:984 RHINELANDER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-3402
Practice Address - Country:US
Practice Address - Phone:347-944-7556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF345439363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily