Provider Demographics
NPI:1922988401
Name:PATLAN MENDOZA, IAN (RN)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:PATLAN MENDOZA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16550 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOWN CREEK
Mailing Address - State:AL
Mailing Address - Zip Code:35672-3706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16550 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOWN CREEK
Practice Address - State:AL
Practice Address - Zip Code:35672-3706
Practice Address - Country:US
Practice Address - Phone:256-460-9559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-159546163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine